year is more than five times higher than it was five years ago. United nurses of alberta president links it to staff shortages. >> It's sad
A broadcast about Alberta nurses earning increasingly large paycheques. The union says it's because of excessive overtime. The United Nurses of Alberta President links it to staff shortages.
the head of the nurses' Union Heather Smith, President of the United nurses of Alberta says it's an indication of just how desperate times
A broadcast about Alberta nurses earning increasingly large paycheques. The union says it's because of excessive overtime. The United Nurses of Alberta President links it to staff shortages.
... a big shake-up in Alberta’s healthcare system, moving the LPNs from AUPE to another union called the United Nurses of Alberta (UNA).
Susan ...
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The Confederacy of Treaty 6 Nations announced Monday it has declared a state of emergency due to the opioid crisis and is calling on provincial and federal governments to provide immediate support.
The Confederacy of Treaty 6 First Nations is calling on provincial and federal governments to provide immediate support to address the deadly opioid crisis.
The nations declared a state of emergency on Monday at their annual general meeting.
The confederacy represents 17 nations of Treaty 6, whose territory covers the central regions of Alberta and Saskatchewan.
Figures provided by the Confederacy of Treaty 6 First Nations show Indigenous peoples in Alberta are seven times more likely to die of opioid toxicity. Leaders say death rates have spiked since the provincial government closed safe consumption sites.
Grand Chief Leonard Standingontheroad said people will continue dying if harm reduction isn't made available and hopes provincial and federal leaders step up to the plate.
"We need action right now, not just talk about it," he said.
Treaty 6 Grand Chief Leonard Standingontheroad congratulated MLAs during the UCP's swearing-in ceremony last month. (Legislative Assembly of Alberta)
The confederacy said 71 First Nations in Alberta have already declared an opioid crisis state of emergency, but only about two dozen have received funding to come up with solutions.
The chiefs noted the Indigenous Health Equity Fund, announced in February, promised $2 billion in federal funding over 10 years, but they said it was not communicated well and funding has not been provided.
Dr. Esther Tailfeathers was senior medical director with Alberta Health Services' Indigneous Wellness Core. (EstherTailfeat1/Twitter)
Dr. Esther Tailfeathers, the former medical lead for the Indigenous Wellness Core Network at Alberta Health Services, applauded the Treaty 6 chiefs for taking a stand.
"All of our nations are suffering and we're burying people daily," she said.
"We're asking for help and nobody's helping."
Tailfeathers, who now works as a family doctor in Blood Tribe, said Indigenous communities are routinely left out of obtaining proper resources to handle addiction issues.
Tailfeathers said recovery treatment beds promised to First Nations are often non-existent or inaccessible and that's part of the reason why her community launched harm reduction treatment programs in 2014.
"[The province] can continue to preach abstinence-based therapies, but people can't even make it to the abstinence-based therapy because they're dying on the streets," said Tailfeathers.
"We're creating an eventual crisis that's going to be even larger than today."
She said if the Alberta government is unwilling to provide support, the federal government needs to step in.
Carolyn Bennett, federal Minister for Mental Health and Addictions, makes an announcement regarding the decriminalization of people who use hard drugs in Vancouver on Jan. 30, 2023. (Ben Nelms/CBC)
Carolyn Bennett, Canada's minister of mental health and addictions, told an event in Edmonton on Monday that solving the opioid crisis means listening to the Treaty 6 chiefs and giving them the support they need.
"There's no treatment model for people who are dead," she said.
Alberta Mental Health and Addiction Minister Dan Williams said in a written statement the province is partnering with First Nations in the spirit of reconciliation.
He joined Indigenous leadership in calling on Ottawa to provide more support to nations, as they have been "absent in this conversation for far too long."
"The federal government has failed to support First Nations to address addiction, and Alberta has been left to address the issues resulting from their failures," said Williams.
"There is no solution to the deadly disease of addiction that does not involve partnerships with First Nations and a shared focus on recovery, which is why Alberta's government is making these investments.
"Our government will continue to work with the Confederacy of Treaty 6 Nations to address the deadly disease of addiction in Alberta."
As for Standingontheroad, he said the confederacy already has a plan on how it will help its people.
"We just want commitment in the dollars to make this happen."
For as much as tobacco and alcohol addiction can have deadly consequences, we would no doubt act swiftly if the safety of addicts were put at risk by tainted cigarettes or booze. While our preference and priority would be to help those individuals overcome their addictions, we certainly wouldn't subject them to a constant game of Russian roulette.
So, yes, harm reduction and access to a "safer supply" are vital in saving lives. Not dying does not mean one has conquered addiction, but it is a necessary prerequisite to that ultimate objective. Alberta has a crisis of opioid deaths and a crisis of opioid addiction.
It is not a matter of choosing harm reduction or treatment and recovery; we need both. Albertans remained in the dark for much of this year as to the extent of the opioid death crisis. For all the claims that the so-called "Alberta model" was saving lives, the province was sitting on data that told a much different story. Last month those data were finally released, and it was chilling and heartbreaking. April 2023 was the deadliest month on record, with 179 opioid-related fatalities recorded. Overall, opioid deaths for the first four months of this year were 6.4 per cent higher than the same period last year. There's also reason to believe that things have worsened since then. New
numbers released last week show weekly EMS overdose responses climbed to an all-time high of 339 in the final week of June. Those numbers tend to track closely with overdose deaths, and so there's a real concern that as bad as April's numbers were, May and June could be worse.
A driving force behind these grim statistics is a street drug supply that is becoming more toxic. Numerous organizations are reporting instances of street fentanyl being cut with other drugs, including xylazine (a type of horse tranquillizer). Amid all of this, the premier has been expanding Alberta's recovery-focused approach. Memorandums of understanding were announced last week between the province and two Alberta First Nations. The plan is to build recovery centres in these communities.
That's laudable, to be sure. But, realistically, how long until these centres are ready to admit patients? How long before they've successfully treated their first patients? Best-case scenario, we're looking well into 2024. And in those intervening months, how many more will needlessly die before they can access that help? If our life-saving strategy is to simply expect addicts to stop using, then why do we need all of these recovery centres? If compassion is driving us to make addiction treatment more readily available, how then do we describe or explain our indifference to these deaths?
In rejecting a harm-reduction approach to the opioid death crisis, the premier and her mental health and addictions minister have made some spurious claims.
Premier Danielle Smith said last week that "we do not believe that there is such a thing as a safe supply of opioids." Of course, some of these very same opioids are provided as painkillers in Alberta hospitals. The proper adjective is "safer." Non-contaminated drugs are demonstrably safer than those that are cut and mixed with other substances. Using those drugs in a supervised consumption setting is demonstrably safer than using alone in the streets. Mental Health and Addictions Minister Dan Williams declared that providing access to a safer supply would be tantamount to "abandoning Albertans." Trying to prevent overdoses and save lives is the opposite of abandonment. It's the removal of those options that has led us to abandon Albertans.
We need to get past the notion that this is an either-or decision. Harm reduction and treatment are both urgently needed right now. Afternoons with Rob Breakenridge airs weekdays from 12:30 to 3 p.m. on QR Calgary and 2 to 3 p.m. on 630CHED rob.breakenridge@corusent.com Twitter: @RobBreakenridge
The city could meet a request from HALO air rescue for annual funding over the next two years, but not consider longer-term support before the next city budget is debated, according to a staff recommendation at city hall.
Last month the society that operates the rescue and medical transport service in the region requested the city join a list of regional municipal donors and provide an annual grant of $500,000 for the next five years.
Monday's public service committee heard that after analysis, staffers found the service is valuable to urban residents, and $1 million spread over this year and next could be found in operating reserve funds.
Council will debate the issue at the July 17 council meeting, where Coun. Cassi Hider said she hopes council lends support.
"The work they do is important and I support providing as much help to them as we can," she said.
When HALO officials appeared before council last month, executive director Paul Carolyn said the group continues to fund raise, and the group's new partial funding agreement with the province is a positive. But, he said, stable funding from the municipalities where it operates provides a crucial part of its budget.
At the time, a majority of councillors noted their personal support for the project, but also raised questions about the city moving in to financially support health issues, which are a provincial responsibility.
As well, Medicine Hat provides funding to other outside groups, but that includes some measure of board representation or budget control.
"My concern is that when we provide operating funds to a nonprofit (agency), how sustainable is it" committee chair, Coun. Ramona Robins asked Monday.
Funds would be provided out of the city's operating reserve for the 2023 and 2024 budget years, but further support would need new approval in the next twoyear budget cycle, covering 2025 and 2026, that will be debated late next year.
The city would also continue to advocate on HALO's behalf to provincial government.
City officials confirmed HALO's stance that about onefifth of its flights are inside Medicine Hat, which forms one frame of consideration for Medicine Hat's contribution,.
But, staff argue, mission volume is not high since 80 per cent of flights in Medicine Hat involve patient transfers, while the remainder are initiated by Medicine Hat police or fire service, or involve search and rescue activities.
A new agreement with the province provides HALO the opportunity to recapture about half its operating expenses from Alberta Health Services - a marked change from previous years when the province paid on a "per-call" basis, but provided no base operating funds.
But, a big portion still comes from large corporations and an effort to bring on towns, cities and counties as long-term donors.
Current municipal funding comes from Cypress County ($300,000 per year until 2026), the County of Newell ($100,000 per year), Forty Mile ($75,000) and Special Areas No. 2 ($35,000). Six other towns and counties in HALO's operational range are also being asked for financial support.
In Alberta, helicopter ambulance service is provided in most of the province by STARS air ambulance with the exception of the southeast, where HALO was created in the mid-2000s, and around Fort McMurray, where another regional service, known as HERO operates.
In 2022 Premier Jason Kenney announced that ongoing operational support would be provided after his government shelved recommendations in a review calling for a single provider in the province to be STARS.
That resulted in AHS providing about 40 per cent of the HALO budget in 2022, and negotiations are ongoing toward the 2023 amount, said Carolan.
The operation's annual budget has risen from $1 million to $3.4 million is recent years as HALO upgraded its helicopter model to one certified to conduct night missions and access roof-top helipads, like the one at Medicine Hat Regional Hospital.
Winnipeg Free Press (Print Edition) - July 11, 2023
Dr. Dan Roberts
Recently, I was asked by the head of respirology, and with the consent of the department of medicine, to advise on the waitlist problem for sleep studies in Manitoba. Despite having initiated the sleep lab at Misericordia Hospital in the 2000s, I was reluctant to involve myself in the issue because my wife is a sleep physician.
However, having reviewed the current situation and recent events leading up to it, disclosure is clearly in the public interest.
The vast majority of diagnostic sleep studies in Manitoba are performed by the Sleep Disorders Centre in Winnipeg. The centre currently receives about 730 referrals per month. Given that it only has sufficient resources to perform about 480 studies per month, the waitlist continues to expand by an estimated 3,000 annually, thereby extending the wait time by as much as an additional six months each year. The current waitlist is approximately 5,900.
Approximately two-thirds of patients can be studied adequately with a home study where patients pick up the device, hook themselves up and return the device and the study recording the next day. One-third of patients need a more complex overnight, supervised in-hospital study.
In 2008, the centre was created to manage sleep disorders provincially. This approach included a group of formally trained specialists and technologists and created a patient-centred approach that would reduce costs to patients and taxpayers and ensure good quality care.
Many provinces allowed private sleep labs at that time (almost 100 in Ontario) and it was suspected that prescription rates for CPAP devices was excessive in these jurisdictions, in cases where evidence did not support CPAP treatment. Businesses that sell devices should not be medically prescribing them. The rate of CPAP prescriptions at the centre is about 55 per cent, versus as high as 80 per cent in other places.
As well, some patients who are referred for sleep studies do not have indications for a sleep study and require alternative assessments. The service was designed to include a centralized referral and scheduling system with a computerized database that could be interrogated to monitor service quality including the tracking of wait times and prescription rates. Automatic screening of referrals ensures patients will be assigned to the most appropriate form of testing.
Even before COVID, the referral rate at the centre began to climb, requests for additional resources were unsuccessful and the waitlist was further compounded during the epidemic. In the fall of 2022, the Diagnostic and Surgical Recovery Task Force invited sleep medicine doctors at the centre to discuss the waitlist.
The doctors submitted an initial proposal to the Winnipeg Regional Health Authority intended to gradually reduce and eliminate the waitlist in six years. In February 2023, a second proposal from the group was submitted to WRHA aimed at eliminating the waitlist in approximately half that time. Neither of these proposals has been funded. Although the task force recently stated publicly that some funding for the centre had been approved, no confirmation or details as to what will be funded has been shared with the sleep doctors.
The PC government, however, had already signed a request for supply arrangement with Cerebra, a private company, to perform 7,500 home sleep studies over 24 months at a cost in excess of $600 per study, and which would have only a minor effect on the wait list. Last week, a government spokesperson inferred that the deal had been expanded to include 10,000 studies. The cost for the first two years will exceed $4.5 million.
There are certainly services that private companies can provide both efficiently and cost effectively. In the case of sleep medicine, these might include dispensing prescribed devices and disposable supplies and instructing patients to use them as well as carrying out home sleep studies. However, if you are selling devices and carrying out diagnostic tests, only a fool would give you the privilege to interpret the test and prescribe a device that generates a profit to you.
If private companies test and sell therapies, then test interpretation and prescription should be done at arm's length – in this case by the centre. Another proviso requires that in order to maintain expertise, a sufficient volume of home sleep testing must be retained by the centre.
Under a public-private arrangement where taxpayers are footing the bill, companies should not be allowed to solicit physician or self-referrals for studies. Their scheduled patients should be provided by the Sleep Disorders Centre from its waitlist.
In order to eliminate the waitlist, there should be a sufficient, temporary ramp up in the number of studies followed by a ramp down in capacity to at least match the input of new referrals. In this particular case, we are starting with a waitlist of 5,900, which is growing by 250 per month. If we want to eliminate the waitlist in three years, we have to perform an additional 14,900 cases over that period or 414 extra cases per month and then ramp down gradually toward the end of that period to 250 additional cases per month.
Unfortunately, no details of the Cerebra arrangement have been shared by the government.
It is clear however that Cerebra has been soliciting private patient referrals, including self-referrals, since last December and that this strategy is failing to provide the expected volumes.
The government has exerted considerable pressure on the centre to provide Cerebra with contact information for patients on its waitlist while refusing to share vital information about how these patients will be diagnosed, treated and followed up.
It is important to understand that the Cerebra deal will have only a moderate and temporary impact on the wait time and will generate a suboptimal level of care. Cerebra is contracted to do 312 studies per month for 24 months, while the waitlist continues to grow by 250 per month. At this rate, even if the contract were to be extended, it would take about eight years to address the waitlist – even if demand didn't increase.
The cost per Cerebra study is an estimated $650. It is unlikely that this would include the physician test interpretation fee, but even if we subtract that, the cost would be about $500 per study. No clinic visit is provided and therefore that expense cannot be included.
In contrast, the centre proposal costing $2.52 million over the same two-year time span would provide an additional 285 studies per month at a cost of $209 per study despite the fact that 12 per cent of these would be the more labour-intensive overnight, in hospital studies required for complex cases. If we add the physician interpretation fee, the cost is $377.10, and therefore, still far less expensive than Cerebra. Despite the much higher cost per study awarded to Cerebra than that requested by centre, Cerebra must still depend on the centre for supplying it with pre-screened and scheduled patients off of its wait list as well as providing subsequent followup care.
This is a real cost and additional work for the centre that the government is not funding. The centre would still have to perform all the complicated in-hospital studies for which it is not resourced, and these patients' wait times would continue to grow. Private companies are under no obligation to share information such as the rate of non-diagnostic studies and device prescription rates, unless stipulated in an agreement – and it is very likely Cerebra's agreement contains no such provisions.
It should be made clear that neither of these proposals would eliminate the waitlist in any reasonable period. As previously stated, the waitlist is growing by 250 per month and the Cerebra deal would generate only 312 tests per month or 62 above than the excess accumulation rate. The SDC proposal would provide only 35 in excess of referrals per month.
These proposals taken separately would take between eight and 14 years to eliminate the waitlist, assuming demand remains constant.
A more sensible approach would have been to approve the centre proposal (providing 285 extra studies per month) and issue a competitive RFP to private vendors for an additional 130 studies per month at a reasonable profit for a three-year term. This would have eliminated the waitlist in three years, cost substantially less than the Cerebra deal and actually would have solved the problem permanently.
It seems obvious why the government doesn't want to discuss this topic. It is difficult to know what role the task force has played in producing this fiasco or at what level of government these decisions were made. We are now left with a very expensive strategy (at least 70 per cent more per study than the centre proposed) that is logistically almost impossible to implement and that will not solve the waitlist. It's clear the privatization agenda is paramount, regardless of the cost or the long-term health consequences. Hard-held ideologies can be self-deceiving and expensive.
Dr. Dan Roberts is acting head of neurology at Health Sciences Centre
