Friday, December 29, 2017

Attention is needed to improve health care in Manitoba

Today, I write about a family who have been affected by the changes in our health care system.  The family wishes to remain anonymous but wants to make sure that there are lessons learned to improve our health care system.  The following is a first-hand account of their experience.

On Sunday, October 22, an elderly woman living in the south east part of Winnipeg was found by her home care nurse to be doing poorly at an a.m. visit.   The nurse called her son to come and help with the care of his mother.   On arrival it was obvious that her health had rapidly deteriorated.   His first thought was to take her to Victoria Hospital which is five minutes from her home, but he knew the Emergency Room was recently closed.  He looked at his mother, seeing that only two days ago she was lively, walking and energetic, now she was responding very little while laying on the couch.  She could not get up on her own and he would not be able to lift her into his car.  The only possibility for help was to call an ambulance.  They dialed 911. 

A few minutes later the ambulance arrived.  The paramedics quickly brought the stretcher into her room; they checked his mother quickly to assess her pulse and breathing.  The son told the paramedics that his mother had a serious heart condition and an implanted defibrillator.  The family requested that she be taken to the St. Boniface Hospital but the paramedics explained that they would have to take her to Grace Hospital due to the closure of the Victoria Hospital Emergency Room.

It seemed odd to him that they would not take his mother to the St. Boniface Hospital which was much closer.  St. Boniface Hospital also has the expertise in advanced cardiac care, so it also seemed logical to take her there.  But no, he was told, the WRHA instructions were very clear - she must go to the Grace Hospital.  The paramedics used rules implemented since the closure of the Victoria Hospital Emergency Room to make the decision that they had to take her to the Grace Hospital even though it was much further away than St. Boniface Hospital.
His mother was taken by stretcher to the ambulance, and proceeded to the Grace Hospital.  Her son arrived at the Grace Hospital shortly after.   When he requested to see his mother, he was told the bad news.  The ER physician advised that his mother's heart stopped in the ambulance and they got it started, but her heart stopped again as she arrived at the ER and they were not able to get it started again.

The family is concerned that their mother might still be alive if she had been taken to St. Boniface Hospital which is much closer and which is fully able to deal with very complicated and serious heart conditions.  They are also concerned that what happened to their mother might happen to others.

The family wants the province to investigate what happened to their mother to fully understand the decisions made by the paramedics that morning, and to see whether changes need to be made to current protocols so that lives can be saved in the future. Paramedics should be able to make the judgement call when dealing with such serious health conditions and the possible damage that can happen to the patient. 

Thursday, December 28, 2017

Chronic Wasting Disease - How big a concern is it? What are governments doing to prevent problems with this disease?

What should we be looking out for in 2018?   One thing to keep an eye on is Chronic Wasting Disease, a disease which is present in deer and elk in Saskatchewan and Alberta and in several states in the United States. It can also infect moose. To date, thankfully, it has not been found in Manitoba. It is related to Bovine Spongiform Encephalitis (BSE)  (Mad Cow disease) found in cattle and to Creutzfeld-Jacob Disease which occurs in humans.  BSE was found to be able to spread to humans and thus great care must be taken in detecting BSE in cattle and in preventing the prion which causes BSE from being transmitted to people.

Until recently it was believed that Chronic Wasting Disease (CWD) was not transmissible to humans, but evidence, first reported in 2017, shows that it can be transmitted to primates (Macaque monkeys) and suggests it could be transmitted to humans.  Thus we need to be especially careful about the presence of CWD in deer and elk and the possibility that people eating deer or elk meet could become infected. 

Though CWD has not been found in Manitoba, it has been found in animals in adjacent areas of Saskatchewan.  I recently wrote to our provincial Minister of Agriculture Ralph Eichler, to ask about the measures being taken in Manitoba to prevent CWD being a problem in Manitoba.   Another reason we need to be extra careful is that CWD is known to be transmitted to hogs, and if CWD were found in hogs in Manitoba this could have a very serious economic impact, as BSE had in cattle a number of years ago. The level of concern is increased because the prions which cause CWD are highly resistant to degradation in the environment, can persist in soil and may contaminate crops and pastures.  My letter to Minister Eichler is below.  I have also written a similar letter to the federal Minister of Agriculture to ask about what the federal government is doing about CWD.

Further information on CWD can be obtained at these sites:
1) CDC report found by clicking on this CDC link.
2) Association of Fish and Wildlife Agencies update at this AFWA site. 
3) In Wisconsin, hunters are being urged to test deer for CWD, and state health and wildlife officials have urged hunters not to consume venison that tests positive for CWD.  In 2016, 442 (12%) of 3,758 deer tested in Wisconsin tested positive for CWD!

My letter to Ralph Eichler

The Honourable Ralph Eichler
Minister of Agriculture
165 Legislative Building
450 Broadway
Winnipeg, MB R3C 0V8

December 18, 2017

Dear Minister Eichler,

I write to inquire about the status of programs at the provincial level currently operating with regard to Chronic Wasting Disease (CWD) a disease which involves prions in a similar fashion to Bovine Spongiform Encephalitis (BCE), commonly known as "mad cow disease".   I note recent evidence that CWD is transmissible to primates.  In these studies CWD was transmitted to Macaque monkeys that were fed infected meat (muscle tissue) or brain tissue from CWD infected deer and elk.  This now creates a concern that humans eating infected meat could become infected, the result being a disease which is similar to Creutzfeld-Jacob disease, a rapid degenerative and fatal brain disorder.

Since swine can readily become infected with CWD after ingesting infected material, even though they may not develop symptoms, there is a concern that swine in Manitoba could become infected with the potential to produce concerns analogous to when Bovine Spongiform Encephalitis (BSE) was discovered in cattle in Canada.

My question is simple.   What is the provincial government doing with respect to prevention approaches to stop the spread of CWD and to ensure we do not have another situation like we had some years ago with BSE?


Dr. Jon Gerrard
MLA River Heights

Thursday, December 21, 2017

Grandview should have an Emergency Medical Services Station - My Letter to the Minister of Health

I have been a passionate supporter of the people in Grandview who want to make sure their Emergency Medical Services station stays open.   As part of this effort, I wrote yesterday to the Minister of Health on behalf of the people of Grandview and area, including the people of Tootinaowaziibeeng First Nation.   My letter is below.

Minister Kelvin Goertzen
Minister of Health, Seniors and Active Living
302 Legislative Building
450 Broadway
Winnipeg, MB R3C 0V8

December 20, 2017

Dear Minister Goertzen,

I write to you with respect to the Emergency Medical Services station in Grandview.

Currently, the Grandview EMS station has one ambulance and 4 paid paramedics who staff the station 70% of the time.   The remaining 30% of the time the station is covered by EMS personnel who are on call.   The population of the Grandview catchment area is currently estimated at 3,070 people.  This includes the nearby Tootinaowaziibeeng First Nation community.

Grandview station has a substantial volume of calls.   For example, for the period July 1, 2017 to Sept 30, 2017, there were 58 primary calls.   This is more calls than in 24 of the 42 other Prairie Mountain Health EMS stations.   Grandview does not have a low call volume.   Indeed, when interfacility transfers are included as well as primary calls, Grandview had 667 calls in 2016, not including 12 standby calls.

For historic reasons, and also because many children from Tootinaowaziibeeng go to high school in Grandview, there is a special relationship between Grandview and Tootinaowaziibeeng.   A representative of the Pallister government said in a meeting on October 13, 2017 that, "the majority of emergency response calls to the First Nation community of Tootinaowaziibeeng came from Roblin."   This  information is not correct.

For the period April 1, 2012 to March 31, 2017, there were 167 emergency response calls to Tootinaowaziibeeng First Nation.   Of these calls, 124 (or 74%) were responded to from Grandview, while 43 (or 26%) came from Roblin.  The average response time for the 124 calls taken from Grandview was 27.2 minutes.  The average response time for the 43 calls taken from Roblin was 32.3 minutes.  This information comes from the government document titled "EMS station Affiliation and Response times to Tootinaowaziibeeng."

My goal on behalf of the residents there, is to make sure you are fully aware of the situation in Grandview, I hope you will review and reverse your decision to close the EMS station in Grandview.  It is an EMS station which makes a major contribution to health care in the Parkland area, and is needed to deliver the best possible care to people in its catchment area.


Dr. Jon Gerrard
MLA River Heights

Wait Times Reduction Task Force Report - exposes lack of action on previous recommendations

The Wait Times Reduction Task Force brought forward its report yesterday.   While Drs Cochinov and McPherson have presented a lengthy report, much of the details are to be found in previous reports which have looked at the function of our emergency medical system and how to improve it.  The Brain Sinclair Inquest report of 2014, as an example, includes a thorough discussion of "patient flow" issues in Emergency Departments and the need to address these. The present report which repeats the emphasis on "patient flow" issues thus exposes the failures of the previous NDP government to implement earlier recommendations, and the failure of the present Pallister government to act in the 20 months they have been in office.

One interesting example of a recommendation which has been talked about for years, with a complete failure of action by both the previous NDP government and the present Pallister government is found on page 60 of the Wait Times Reduction Task Force report.   The recommendation is for "Quick admission to a special stroke unit".  For about 15 years, it has been well known that it is critical to have a dedicated stroke unit in Manitoba.   All other provinces including Prince Edward Island have dedicated stroke units.   In opposition, the Pallister Conservatives castigated the NDP for not acting.  In their first 20 months in office the Pallister Conservatives have done nothing with respect to a dedicated stroke unit.  Thus the report of the Wait Times Reduction Task Force exposes the lack of attention by the Pallister Conservatives to the known critical needs in Manitoba in the last 20 months.

Dr. Cochinov says behavioural and cultural change is needed with respect to the Wait Times Reduction Task Force report.   One of the essential changes is to actually implement the recommendations as so many past recommendations still remain outstanding.

Friday, December 15, 2017

Standing up for CancerCare Manitoba - care of extraordinary quality

The KPMG report on Health Care says the following about CancerCare Manitoba "Organizations like CancerCare Manitoba .... operate independently within the public system. .... There is not clear evidence that these organizations are more effective at delivering key management services despite leadership claims that they have more cost-effective or sustainable operations."   This statement by KPMG, is wrong, and is based on a lack of knowledge by those who wrote the KPMG report.  I will explain why.

CancerCare Manitoba provides the best specialist network in Manitoba.

- It has a clear provincial mandate which is recognized in legislation.
- It has a province-wide network including 16 outreach centres in various parts of Manitoba.   Approximately one third of all cancer chemotherapy is given in these outreach centres.  Their impact is enhanced through the use of telehealth to provide a substantial amount of care and follow up.  This is very efficient for patients and for professionals.
- The outreach centres are connected so that all health professionals involved in care have access to the electronic medical record with the parts of the patient's medical chart they need to deliver care for the patient.    There are standardized high quality protocols to facilitate the delivery of the best possible care for patients.  The treatment protocols are updated on a regular basis, working with national and international teams so that they meet the best global practices.  The electronic medical record system ensures privacy because it has very tight controls on access, and as part of its design it tracks those who access the record.
- In addition to diagnostic and treatment services, CancerCare Manitoba provides epidemiological and preventive approaches using the latest information. Province-wide prevention of colon cancer and vigorous efforts for the early detection of breast and cervical cancer are examples of the focused effort on prevention which improves health, decreases disease burden, saves lives and saves costs by reducing the need for diagnostic and treatment services.
- CancerCare Manitoba also ensures sufficient trained health professionals are present in the province to deliver care.  As one example, CancerCare Manitoba trains doctors, nurses and pharmacists at outreach centres to ensure the highest quality care throughout the province.  Cancer Care Manitoba also provides the ongoing continuing medical education so health care professionals are always using the latest medical knowledge available.
- CancerCare Manitoba is well integrated into provincial health care delivery with agreements with each of the Regional Health Authorities, and regularly reporting to the Minister of Health on its plans and outcomes (see below).  Further the Board of CancerCare Manitoba has representatives from the WRHA, St. Boniface General Hospital and the Minister of Health. It is therefore a well-integrated part of Manitoba's health care and is not an "independent operator" as KPMG describes it.
- Health professionals at CancerCare Manitoba are involved in research ranging from basic science to advanced clinical trials.   The clinical trials which are being and have been conducted have studied the optimization of care, looking at reductions in care as well as increases in care, including in some cases at options which result in decreased costs to optimize costs as well as care.
- CancerCare Manitoba provides the Minister of Health with an annual work plan and a comprehensive annual report and a statistical and epidemiological report.
- As further evidence for how well CancerCare Manitoba (CCMB) is integrated into the health care system, CCMB has managed the WRHA Oncology Program since its inception and this past fall had the oncology clinics at Victoria, Concordia, Seven Oaks and Grace Hospitals transferred to its overall management.  As well, through the United Primary Care and Oncology Program (UPCON), many family practice clinics in Winnipeg have appointed physicians who are trained by MMCB who are now taking responsibility for the continuing care and follow up of cancer patients after their initial treatment.

Though other specialist networks - heart disease, kidney disease, brain health  etc - may have elements of these activities, no other specialist network is as comprehensive, or has similar ability to control quality and costs of services.   CancerCare Manitoba compared to other specialist programs is thus unquestionable more effective in delivering key management services, and has built in approaches to ensure care is cost effective, of high quality and is sustainable.   The statements I quote above from the KPMG report are clearly wrong and based on a poor knowledge by the authors of the KPMG report.

While CancerCare Manitoba may not be perfect, it is an example of how a specialist network can be built to include high quality multidisciplinary teams to deliver high quality province-wide care.  Instead of trying to cast aspersions or doubts about CancerCare Manitoba, the KPMG report authors should have pointed out that it is a model of excellent care delivery which could be emulated.

It is important that the Minister of Health knows the shortcomings of the KPMG report.  For this reason, I raised this issue in Question Period on December 7, 2017.   The text from Hansard is below.  A video of my question and the Minister's answer can be seen by clicking on this link   

From Hansard:

CancerCare Manitoba - KPMG Report

Hon. Jon Gerrard (River Heights): Madam Speaker, in the government's accountant-run approach to health care, the KPMG comments, which I table, on CancerCare Manitoba are ignorant and wrong. CancerCare Manitoba has the best integrated approach to specialist service delivery in the province, including epidemiology, prevention of cancer as well as superb diagnostic and treatment services, a province-wide network of 15 outreach centres connected by shared electronic records and high-quality standardized protocol.
      I ask the minister: Will he fact-check the incorrect statements made by KPMG on CancerCare Manitoba before making any changes in its situation?

[Sadly, the Minister went completely off topic in his reply - below]

The Hon. Kelvin Goertzen (Minister of Health, Seniors and Active Living): I've fact-checked the member opposite. He was asking questions yesterday on EMS in Grandview and wondering why we were proceeding with the Reg Toews report.
      On May 24th in this House, so hardly a year ago,  the member stood up and said: There was an  excellent review conducted by Reg Toews of Manitoba's EMS services with a report released three years ago in 2013. Very few of the recommendations have been fully implemented to date. Urgent action is  needed. As Liberals, we will be watching the new  government carefully and we'll be pressing for action. Paramedics of Manitoba deserve no less.
      That's what he said a year ago. If he wants to be a weather vane and twist in the wind, he can do that; we'll stand on principle, Madam Speaker.

Sunday, December 10, 2017

Eighteen studies showing a reduction of nitrous oxide emissions from agriculture by 30% or more

In a previous blog post on nitrous oxide, I have made the point that it is feasible to reduce production of the greenhouse gas nitrous oxide form agricultural sources by one third.   In this post I list eighteen studies in which nitrous oxide emissions have been reduced by 30% or more:  These studies illustrate the feasibility of reducing nitrous oxide by one-third.  It should be noted that the findings, when looked at carefully, suggest that approaches taken may need to be adapted to the particular local soil, crop and environmental conditions.

The studies showing reduction of nitrous oxide by more than 30% are listed below:

1) Using a nitrification inhibitor or polymer coated urea can reduce nitrous oxide emissions by 35-38% compared to conventional fertilizer (reference 1).
2) Using fertilizer placed at a depth of more than 5 cm, compared to a depth of less than 5 cm, combined with reduced tillage resulted in reductions of nitrous oxide of greater than 30%.  This involved a meta-analysis of 239 comparisons.   The impact of no till and reduced tillage alone to reduce nitrous oxide was most effective when carried out for more than 10 years (reference 2).
3) Using urea with a urease inhibitor and a nitrification inhibitor compared to no inhibitor reduced nitrous oxide emissions by 37% (reference 3).
4) Using urea compared to anhydrous ammonia reduced nitrous oxide production by 50% in corn fields (reference 4).
5) Using polymer coated urea decreased nitrous oxide production and poultry litter increased nitrous oxide emissions compared to other sources of nitrogen with differences from 46 to 81% in the comparisons. (reference 5).
6) Using liquid swine or dairy manure compared to solid poultry manure resulted in a 41% decrease in nitrous oxide emissions (reference 1).
7) Urea ammonium nitrate together with a nitrification inhibitor resulted in a 19 to 67% reduction in nitrous oxide emissions (reference 6).
8) Urea applied with a urease inhibitor and a nitrification inhibitor resulted in a 46% reduction in nitrous oxide emissions compared to the application of urea without any inhibitor (reference 7).
9) Polymer Coated Urea resulted in a 42% reduction of nitrous oxide emissions compared to regular urea (reference 1).
10) Urea ammonium nitrate with urease inhibitor and nitrification inhibitor resulted in a 61% reduction in nitrous oxide emissions compared to urea with no inhibitor (reference 1).
11) Urea ammonium nitrate with urease inhibitor and nitrification inhibitor resulted in a 41% reduction in nitrous oxide emissions compared to urea ammonium nitrate alone (reference 1).
12) Urea ammonium nitrate resulted in a 35% reduction in nitrous oxide emissions compared to urea. (reference 1).
13) Urea ammonium nitrate with soluble methylene ureas and urea trizones resulted in a 57% reduction in nitrous oxide emissions compared to the use of urea (reference 1).
14) Changes in source, time and place of application compared to standard practice have been associated with a 20 to 80 percent reduction in nitrous oxide emissions (reference 8).
15) Calcium ammonium nitrate reduced nitrous oxide emissions by 54% compared to manure (poultry, or liquid swine or liquid dairy)  (reference 1).
16) Fertilizers with urease inhibitors and nitrification inhibitors reduced nitrous oxide emissions by 38% compared to fertilizers with no inhibitors (reference 9).
17) Commercial fertilizer reduced nitrous oxide emissions by 40% compared to manure (reference 1).
18) Urea with nitrification inhibitors reduced nitrous oxide emissions by 81-100 percent compared to urea with no inhibitor (reference 10).

The references for these studies are shown below:

1. Snyder CS, Davidson EA, Smith P and Venterea RT: Agriculture: sustainable crop and animal production to help mitigate nitrous oxide emissions. In. Current Opinion in Environmental Sustainability.  Vol 9-10: pages 46-54, 2014.
2. Van Kessel, C, Verterea R, Six J et al.  Climate, duration, and N placement determine N20 emissions in reduced tillage systems: a meta-analysis.  Glob Change Biol 19:33-44, 2013.
3. Zaman M, Nguyen ML, Blennerhassett JD et al: Reducing NH3, N20 and N03 - N losses from a pasture soil with urease or nitrification inhibitors and elemental S - amended nitrogenous fertilizers.  Biol Fertil Soils 44:693-705, 2007.
4) Venterea RT, Dolan MS, Ochsner TE: Urea decreases nitrous oxide emissions compared with anhydrous ammonia in a Minnesota corn cropping system.   Soil Sci Soc Am J 74:407-418, 2010
5. Sistani KR, Jn-Baptiste M, Lovanh N et al.  Atmospheric emissions of nitrous oxide, methane, and carbon dioxide from different nitrogen fertilizers.   J Environ Qual 40:1797-1800, 2011.
6. Omonode RA, Wyn TJ; Nitrification kinetics and nitrous oxide emissions when nitrapyrin is coapplied with urea ammonium nitrate. Agron J 105:1475-1480, 2013.
7. Halvorson AD, Snyder CS, Blaylock AD et al: Enhanced-efficiency nitrogen fertilizers: potential role in nitrous oxide emissions mitigation.  Agron J 106:715-722, 2014.
8. Snyder CS, Fixen PE: Plant nutrient management and risks of nitrous oxide emissions.   J Soil Water Conserv 67:127A-144A, 2012.
9. Decock C: Mitigating nitrous oxide emissions from corn cropping systems in the midwestern US: potential and data gaps.  Environ Sci Technol 48:4247-4250, 2014.
10. Soares J, Cantarella H, Vargas V et al: Enhanced-efficiency fertilizers in N20 emissions from urea applied to sugarcane.   J Environ Qual  10.2134/jeq2014.02.0096, 2014.

Nurse Practitioners need to be involved and considered in health care planning

Nurse Practitioners are a key part of ensuring we have an excellent health care system.  Some progress was made under the NDP government, but there was not a clear and continuing plan for the integration of nurse practitioners into health care delivery.   One step forward was the implementation of seven quick care clinics, five in Winnipeg, which were run by nurse practitioners.  There was also a gradual increase in nurse practitioners in access centres and a slow increase in nurse practitioners being involved in rural centres where there were no physicians.   Sadly, the Pallister PCs  are closing 4 of the 5 quick clinics in Winnipeg, have ended the Hospital Home Team, are closing the Corydon Primary Care Clinic and have terminated the positions of more than 20 nurse practitioners.  While some will get new positions, there will be a net  loss of nurse practitioner positions - the opposite of what it needed.

While I have considerable concerns about aspects of the Peachey report, one item that he got right was in realizing it will be important to have more nurse practitioners involved in delivering health care in Manitoba.  On November 24th, I asked the Health Minister about his plans to include Nurse Practitioners in Manitoba's health care.  The text from Hansard is below:

The answers were very unsatisfactory, so I helped the Nurse Practitioners to organize a luncheon encounter to meet MLAs so that all MLAs would have an opportunity to meet with Nurse Practitioners and learn more about their situation and the need for action now (photo below).

From Hansard:

Nurse Practitioners - Training and Recruitment

Hon. Jon Gerrard: (River Heights): Madam Speaker, I welcome Ashley Pylypowich, chair of the Nurse Practitioner Association of Manitoba, who's in the gallery today.
      Nurse practitioners are a very critical part of Manitoba's health-care team. David Peachey, in his report, recognized this, and, indeed, his report calls for a dramatic increase in the number of nurse practitioners in Manitoba, possibly as many as 500 more nurse practitioners than there are today.
      What is the government's plan with respect to nurse practitioners, including the plan to train and recruit the additional nurse practitioners who will be needed for our province?
Hon. Kelvin Goertzen Minister of Health, Seniors and Active Living): We certainly value and appreciate the work of nurse practitioners. I agree they are certainly an important part of the pro­fessionals within our health-care system.
      I'm a little confused by the member for River Heights. He has spent the last many months trying to distance himself from Dr. Peachey's report, saying that it wasn't what he would do. Well, of course, that's what he said one day, and then he said he would do it, and then he said he wouldn't do it.
      So I'm not quite sure. Does he support Dr  Peachey's report, or does he not support Dr. Peachey's report, Madam Speaker?
As you can see from Mr. Goertzen's response, he has no plan with respect to nurse practitioners, and used almost all of his time in a diversionary discussion of the Peachey report.  

Madam Speaker: The honourable member for River Heights, on a supplementary question.
Mr. Gerrard: In a problematic report, there are some things which are worth looking at. Nurse practitioners are a really critical part–of our health-care system. And yet the minister has failed thus far either to meet with members of the Nurse Practitioner Association of Manitoba or to include members in decision-making committees like that for the Shared Services, Manitoba clinical teams or even in ongoing discussions on the future of health care in our province.
      When will the minister realize how critical nurse practitioners are and include them in his plans for the future of health care in Manitoba?
Mr. Goertzen: Well, Madam Speaker, now I think we get a bit of a sense of what a true Liberal is: not quite sure from day to day what they're actually standing for.
      The–Dr. Peachey's report is an overall clinical plan. Now, it's true that it can't all be done at one time; it has to be staged, perhaps over many years, Madam Speaker, the different parts of it, and that is fine. But it's not a buffet where you take a little bit here or you take a little bit there and leave the rest of  it over there. Dr. Peachey's plan is an overall comprehensive plan.
      Yes, nurse practitioners are an important part of that. We continue to value them. We will continue to value them. But I think he should come on-board with looking at the overall plan and not just picking and choosing so he can have a question one day in question period, Madam Speaker.

The issue in my question is including nurse practitioners in planning moving forward.  As you can see from Mr. Geortzen's response he completely avoided the critical issue which needs to be addressed.

Madam Speaker: Order. Order.
      The honourable member for River Heights, on a final supplementary.
Mr. Gerrard: Madam Speaker, nurse practitioners run the Quick Care Clinics in Winnipeg. The minister is cutting four of these. Chop.
      Nurse practitioners are critical to collaborative-care teams like the Corydon Primary Care Clinic and the Hospital Home Team. The minister is cutting these. Chop.
      When we all know nurse practitioners will be critical in future health care and the Peachey report is recommending more nurse practitioners and a greater role for nurse practitioners, why is the minister cutting these nurse practitioners positions? Chop.
Mr. Goertzen: Madam Speaker, the QuickCare clinics' resources are going to the ACCESS centre. The hours will be expanded, so there'll actually be more services.
      But it is important, since the member brought it up, that we did go to Ottawa over the last year and we begged the federal Liberal government to be a real partner in health care. We said, would you please come to the table and help us provide health care? And you know what they said? Chop.  [The federal government gave the Pallister government a 3% increase plus additional funding for home care, for mental health and other items.]
      They reduced the funding, Madam Speaker. We went to–we said, but there are people in Manitoba who need support for mental health care. You know what they said? Chop. [Increased funding is hardly chopping]
      We went and we asked and we said there are people who need more support when it comes to acute care. Will you help us? You know what the federal Liberal government said? Chop. [The federal government gave the Pallister government a 3% increase plus additional funds for home care and mental health.  We are still waiting for progress by the provincial government in mental health and home care.]
      And you know what that member said? Nothing, Madam Speaker. [In fact the three Liberal MLAs went to Ottawa to call for strong funding for health care.   And we would have done more but the Pallister Conservatives have not yet presented a good plan for health care in our province - including no plan for mental health or home care.   It is very hard to make a strong case for additional funding if you don't have a good plan]. 
Overall, our Minister of Health, Mr. Goertzen, gets very poor marks when it comes to addressing the issues of nurse practitioners.   Including nurse practitioners in our health care system is a vital aspect of improving health care in Manitoba.  A robust plan is needed.   We are not there yet.

Monday, December 4, 2017

It is long past time for an effective approach to reducing suicides in Manitoba.

November 19th in an article in the Winnipeg Free Press, Dr. James Bolton, medical director of the Winnipeg Regional Health Authority Crisis Response Centre admitted that "The treatment we have for suicidal people in the health system is abysmal.  There is no suicide specific treatment in Manitoba."

These damning comments came in response to a report "Toward Quality Mental Health Services in Canada" which shows that Manitoba is an outlier with far higher rates of attempted and completed suicides in our province than in Ontario, Alberta and British Columbia.

This is an area where Judy Klassen (MLA for Kewatinook) and I have been very concerned for some time.  In 2007, a man who was suicidal went to a Winnipeg Emergency Room for help.   He was assessed and then sent home with a bus pass.  Soon after, he committed suicide.    In 2008, in response to this tragedy, Kevin Lamoureux and I introduced The Mental Health Bill of Rights - Bill 230, into the Manitoba Legislature.   The NDP did not support the legislation and little changed.

October 24, 2015, Reid Bricker, who was suicidal, was released form the Health Sciences Centre at 3:20 am.   He had attempted suicide twice in the days leading up to this and had twice before in that short period been discharged from Winnipeg hospitals.  His parents were not informed at the time of his discharge, and there was no peer support worker or other person who would stay in touch with him.  He committed suicide and was found months later in the Red River.  Ever since, his mother, Bonnie Bricker, has dedicated herself to pushing for a better approach to mental health in Manitoba.  It is therefore very sad and troubling to hear Dr Bolton's assessment of the current situation.

I asked the Health Minister, in Question Period, on November 22, about the fact that there is not a specific approach to those who are suicidal in Manitoba - that the health system here in Manitoba is abysmal when it comes to addressing suicide.   My question and the Minister's response is in a video at this link and in the text below.

The Minister has been in his post for almost two years.   It is long past time for him to have put in place an effective approach to suicide prevention and for help for those who are suicidal.   He needs to act quickly, because what is there now is not good enough. 


Mental Health Services - Suicide Prevention Treatment

Hon. Jon Gerrard (River Heights): Health care is important, yet for at least a decade under NDP and PC governments Manitobans who are suicidal and who are going to emergency rooms or crisis centres, but not getting the help they need, end up taking their own lives.
      Three days ago, Dr. James Bolton, medical director of the WRHA Crisis Response Centre, talked of the situation under the Premier's watch, and he said the treatment we have for suicidal people is abysmal. There is no suicide-specific treatment in Manitoba.
      Why does the Premier always make excuses and blame others instead of acting, himself, as a top priority to deliver suicide-specific prevention.?
Hon. Kelvin Goertzen (Minister of Health, Seniors and Active Living): Well, Madam Speaker, we know that any suicide, regardless of where it happens in Manitoba, is a tragedy, is a lost life. It is lost hope. It is a lost loved one for that family.
      Yesterday, in the Throne Speech we committed to look at peer support for mental health in emer­gency rooms. It's something that's been looked at in other jurisdictions with some success. We're reviewing proposals when it comes to peer support for mental health in emergency rooms.
      We also have the ASIST program for suicide prevention, which is offered through Klinic for–Klinic with a K–and last week, I was pleased to provide additional support for that suicide intervention program for Youth for Christ on Main Street.

Sunday, December 3, 2017

We must end the normalization of the unconscionable - Manitoba's high child poverty rate is not acceptable.

Under the former NDP government and now under the current PC government in Manitoba, our province has an extraordinarily high child poverty rate.   On November 21, Campaign 2000 released its latest report which showed that Manitoba has a child poverty rate of 27.5% - that more than a quarter of Manitoba children live in poverty.  We have, sadly, the highest child poverty rate of all provinces.  The average across Canada is 17.5%, a full ten percent below Manitoba.  The high rate of poverty has continued for so long that it is now expected.  The unconscionable has been normalized.  This in not acceptable.

While federal policies are important to our national effort, the fact that Manitoba has the highest child poverty rate shows that Manitoba, compared to other provinces has poor policies with respect to reducing child poverty.   I have spoken out many times about the need for better efforts to reduce poverty in Manitoba.  In 2008, Kevin Lamoureux and I introduced Bill 226, the Social Inclusion and Anti-Poverty Act.   The NDP followed with a poverty reduction plan but it was not effective.  I have also promoted a basic income program for Manitoba.

On November 22, I asked the PC government why they had been so slow in acting on their commitments to make poverty reduction a priority.  My question and the government's response can be seen clicking on this link - Gerrard question on poverty: - or in the text from Hansard below.

It needs to be noted that while Scott Fielding, in his answer, claims he has expanded the rent assist program, in fact funding has been reduced - see this link.  Further his claim to have helped reduce poverty by increasing the basic exemption has done little to address poverty - indeed, the reduction in tax is much large for high income earners than for those on low incomes. 

It does, however, need to be mentioned that in response to Campaign 2000's report and my questions in the Manitoba Legislature, the government has announced consultations which are promised to lead to a plan to reduce poverty, and a committee meeting is being held Dec 4 to look at poverty reduction.  However, words and intentions will mean little until we actually see a significant reduction in poverty in Manitoba.    

FROM HANSARD - Nov 22, 2017

Poverty Reduction - Government Plan

Hon. Jon Gerrard (River Heights): Health is important, and poverty is a root cause of many health issues. Yesterday, Campaign 2000 reported that Manitoba has the highest provincial rate of child poverty. In 1992, the PC government rolled back the social assistance levels to 1986 rates, and PC and NDP governments in the years since have essentially left it there.
      Since being elected, the Premier (Mr. Pallister) and his Cabinet changed the balanced budget law to give themselves a 20 per cent raise. Their changes to the basic exemption meant top earners got the biggest breaks.
      Why has this government delayed, delayed and delayed some more in introducing a poverty reduction plan? Is this yet another broken promise?
Hon. Scott Fielding (Minister of Families): Addressing poverty is an issue this government takes very seriously. We know that the previous NDP government got it all wrong. In fact, they were leading the nation in terms of child poverty for many, many years, and that's why we've taken some concrete action in terms of the amount of people that have access to the Rent Assist program. Over 2,200 more people are supported under the Rent Assist program.
      We've also reduced the basic–we've also changed things in terms of the basic personal exemption, where over 2,100 individuals are off the tax rolls altogether.
      These are some of the items that we think will help address people and put more money in people's pockets.