It’s hardly the first relationship to struggle under the pandemic’s health and financial pressures, but Canada’s dysfunction-prone federation appeared to be in need of a skilled mediator or two this week.
Like aggrieved partners now speaking only through lawyers, premiers gathered in Victoria, B.C. on July 11-12 to reprise their call for an urgent First Ministers meeting to negotiate an increase to the Canada Health Transfer (CHT). As premiers made their pitch to assembled journalists, senior federal ministers popped up in the media to blow off their demands.
“Where’d the love go?” soon-to-retire B.C. Premier John Horgan said in his final press conference as chair of the Council of the Federation. “Everything was so fine. And then it wasn’t.”
To reporters who covered the several dozen first ministers’ meetings held during the COVID scramble, it seems a bit revisionist to say the relationship was “fine” during the pandemic.
Sure, the first ministers talked a lot (virtually). But it took a lot of talking to hold together all that was coming apart in that emergency, and to pursue border restrictions and vaccination policies.
Patience is frayed now because Prime Minister Justin Trudeau hasn’t been meeting with the premiers in person. One-time funding for specific things like surgical backlogs was announced by Health Minister Jean-Yves Duclos in March but Finance Minister Chrystia Freeland’s spring budget offered nothing longer-term.
“Ghosted,” is how Horgan described — “with sadness, not anger” — what he sees as a lack of federal engagement.
Horgan said federal Intergovernmental Affairs Minister Dominic LeBlanc only got around to calling him to check in prior to the meeting last Sunday morning, as premiers were already winging their way to Victoria.
“Is there anything else on his docket beyond the 13 of us?” the premier said. “I wouldn’t think so, but here we are.”
The day after the premiers went home, Freeland’s office issued a press release confirming she’d just transferred the $2 billion top-up to the CHT Duclos promised. It gave reporters a chart describing how transfers break down by jurisdiction. And then Freeland left for the G20 finance ministers meeting in Bali, Indonesia.
Practitioners and patients agree — the health care system is breaking down. But the governments responsible appear to be in a stalemate, counting on each other’s inaction to distract from their own ineffectiveness.
‘Fake’ figures and ‘triple Rs’
The shots fired this week were aimed at two things: math and accountability measures.
LeBlanc called the premiers’ figures on the federal contribution to health care “fake.”
The premiers are still using the same favourable-to-them calculation they’ve put out for months to make the case that Ottawa is no longer paying its share.
Was the CHT ever intended to pay for half of rising health costs? Not really. But did LeBlanc really need to use a provocative term like “fake”?
Both sides agree new investments are needed. Trudeau maintained Wednesday they’re still coming.
“The federal government will be there to invest in health care,” he said, “but we are going to make sure that those investments deliver for Canadians.”
And that’s where the accountability fights start.
The federal instinct to attach strings and safeguards is understandable. Ask Stephen Harper how it feels to reform equalization payments at the request of lobbying premiers — only to watch one use the new money to roll out a big provincial tax cut. More recently, provincial watchdogs concluded that billions of dollars in federal COVID support for the provinces was not spent as intended by Ottawa.
But federal ministers who try to tell provinces how to spend in an explicitly provincial jurisdiction like health can expect some pushback. That may explain why Duclos, in a recent interview with CBC News, sounded like a management consultant giving a Ted Talk — framing his arguments around what he called a “triple-R rule”: respect for jurisdiction, shared responsibility, and a focus on results.
“The federal government is unable and will never try to micromanage the health care system in Canada,” he said.
Negotiations have to be “sequential”, Duclos said. Health ministers must first meet to set the “results” they want to achieve — a process that’s not finished yet, apparently — before anyone can talk money, he added.
‘Ragging the puck’
Premiers pushed back hard at the suggestion that they can’t be trusted to spend health transfers on health. Their books are public, they told reporters in Victoria, and they should be scored by the voters who elect them, not according to some checklist on Duclos’ desk.
Horgan accused Ottawa of claiming a problem that doesn’t exist. Holding back federal money until certain conditions are met would be a “cop out,” he said, and attaching strings to new health care funding makes it seem as if the two levels of government have a master-and-serf relationship. (He’s not wrong. Constitutionally, the provinces are not subordinate to the federal government, even if the federal government has demonstrably more fiscal capacity.)
Alberta Premier Jason Kenney, a lame duck premier now free to speak as who will never again have to negotiate with the feds, put it bluntly.
“If they’ve got something to say to us about conditions, come and sit down and say it,” Kenney said. “But so far, it just looks like they’re ragging the puck because they have no intention of paying their share.”
To sum up: the feds say they won’t negotiate the cash until they’ve worked out the conditions, while the provinces remain wary of any conditions and say they can’t proceed without more cash.
Trudeau’s vague explanation for not meeting with the premiers to discuss the CHT is based on bandwidth: a pandemic, he said, isn’t the time.
But when the federal government wanted a national child care program in the middle of the pandemic, it put up the money first and then found the time and energy to negotiate a custom slice for each province.
Freeland’s current fiscal framework lacks a CHT hike and she’s warned more restraint is required to counter high inflation. What message does that send about her intentions?
The federal government also pointed to election timing as one reason for the lack of engagement between the PM and premiers on health spending. The Liberals say they fought a bruising federal election last fall and didn’t want to meddle in the Ontario and Quebec election campaigns this year.
Will Trudeau’s calendar suddenly free up after Quebecers vote in October? Or was that just an excuse to kick the can?
Pushback and payback
Two signs emerged this week that the provinces want to raise the political cost of federal inaction. One was a public relations gambit, while the other threatens to take hostage some Liberal policy priorities.
CBC News reported that the premiers are considering a national advertising campaign to make the case to Canadians that their health care system will suffer if the federal government doesn’t spend more on it.
A new “blame Ottawa” offensive could redirect anger away from provinces responsible for backlogs and bad health care experiences. But it ignores a point made by health care advocacy groups — that some reforms, such as interprovincial recognition of professional licences and credentials, can happen without an argument with Ottawa over money.
The potential hostages are the Liberals’ pledges to implement national pharmacare and dental care coverage – two conditions set by the federal NDP earlier this year in return for its support on confidence votes in the House of Commons.
Adding drug and dental coverage, Horgan said, isn’t possible without a “firm foundation” of financing for the services already covered.
“You can’t get to one without the other,” he told reporters.
Since federal officials need provincial cooperation to implement national schemes outside federal jurisdiction, could these programs slow-walk or stall until the CHT increases?
That might test the patience of the federal New Democrats currently protecting Trudeau from snap election threats.
The first big win for the Council of the Federation (COF) in 2004 was a deal with Paul Martin’s Liberal government on health funding.
At its inception, COF was supposed to be about leading in its own right, not waiting for Ottawa to solve national problems. And Canada’s premiers showed themselves capable of more than lobbying the feds by coming up with an agreement on bulk drug purchasing and the imperfectly implemented interprovincial trade deal.
But there were no actions or announcements approaching the significance of those measures in this year’s COF communiqué. Instead, it piled on more demands for Ottawa beyond health care, on things like infrastructure and immigration.
Did losing a few years’ worth of in-person meetings make it difficult to advance other files? Perhaps.
Victoria’s Empress Hotel was full of officials getting face time again with their colleagues across the 13 jurisdictions. Media were denied access to not only their meetings but also their social and networking events, so it’s possible reporters simply couldn’t get a line on other work going on behind the scenes.
The earnest rhetoric in Victoria made evident the premiers’ collective determination to prevail in a 2022 rematch of the health transfer payment fight. But it’s possible they focused on federal demands because they had no progress to announce on other things under their control.
A First Ministers meeting won’t fix that.
Medical assistance in dying given to 10K Canadians in 2021 – CTV News
More Canadians are ending their lives with a medically-assisted death, says the third federal annual report on medical assistance in dying (MAID). Data shows that 10,064 people died in 2021 with medical aid, an increase of 32 per cent over 2020.
The report says that 3.3 per cent of all deaths in Canada in 2021 were assisted deaths. On a provincial level, the rate was higher in provinces such as Quebec, at 4.7 per cent, and British Columbia, at 4.8 per cent.
“It is rising remarkably fast,” University of Toronto law professor Trudo Lemmens, who was a member of the Council of Canadian Academies Expert Panel on Medical Assistance in Dying, wrote in an email to CTV News. He noted that some regions in the country have quickly matched or surpassed rates in Belgium and the Netherlands, where the practice has been in place for over two decades.
Advocates say it isn’t surprising because Canadians are growing more comfortable with MAID and some expect the rising rates may level off.
“The…. expectation has always been it (the rate) will be something around four to five per cent, (as in) Europe. We will probably, in the end, saw off at around the same rate,” said Dr. Jean Marmoreo, a family physician and MAID provider in Toronto.
The report uses data collected from files submitted by doctors, nurse practitioners and pharmacists across the country involving written requests for MAID.
Among the findings:
- All provinces saw increases in MAID deaths, ranging from 1.2 per cent (Newfoundland & Labrador) to a high of 4.8 per cent (British Columbia);
- More men (52.3 per cent) than women (47.7 per cent) received MAID;
- The average age was 76.3 years;
- Sixty-five per cent of those provided with assisted death had cancer. Heart disease or strokes were cited in 19 per cent of cases, followed by chronic lung diseases (12 per cent) and neurological conditions like ALS (12 per cent);
- Just over two per cent of assisted deaths were offered to a newer group of patients: those with chronic illnesses but who were not dying of their condition, with new legislation in 2021 allowing expanded access to MAID.
Documents show that 81 per cent of written applications for MAID were approved.
Thirteen per cent of patients died before MAID could be provided, with almost two per cent withdrawing their application before the procedure was offered.
Four per cent of people who made written applications for medical assistance were rejected. The report says some were deemed ineligible because assessors felt the patient was not voluntarily applying for MAID. The majority of requests were denied because patients were deemed not mentally capable of making the decision.
But other countries with long-established programs reject far more assisted death requests, said Lemmens, citing data that shows 12 to 16 per cent of applicants in the Netherlands are told no.
“It ….may be an indication that restrictions (in my view safeguards) are weaker here than in the most liberal euthanasia regimes,” he wrote in his email to CTV News.
But Marmoreo, who has offered MAID since 2016, sees Canada’s low rejection rate differently.
“It is more like that the right cases are put forward,” she said.
“We have a very good screening process right from the get-go. So before people actually even make a formal request to have assisted dying, they have a lot of information that’s been given to them by the intake….here’s what’s involved in seeking an assisted death, you must meet these eligibility criteria.”
B.C. ‘clear’ there’s not enough housing as Vancouver encampment ordered dismantled
VANCOUVER — British Columbia’s acting attorney general says the province was “clear” with Vancouver officials that the Crown corporation responsible for subsidized housing does not have enough spaces available for people who are being told to dismantle their tents along a street in the city’s Downtown Eastside.
Murray Rankin, who is also the minister responsible for housing, says housing is a human right, and the “deeply concerning scenes from Hastings Street demonstrate how much more work we have to do to make that a reality for everyone in our communities.”
Rankin in a statement Friday says BC Housing has accelerated efforts to secure new housing for encampment residents including pursuing new sites to lease or buy and expediting renovations on single-room occupancy units as they become vacant.
He says BC Housing is aiming to make a “limited number” of renovated units available next week, with more opening later in the fall.
Vancouver fire Chief Karen Fry ordered tents set up along Hastings Street sidewalks dismantled last month, saying there was an extreme fire and safety risk.
Police blocked traffic Tuesday as city staff began what’s expected to be a weeks-long process of dismantling the encampment but little had changed by the end of the week with most residents staying put, saying they have nowhere to go.
The city has said staff plan to approach encampment residents with “respect and sensitivity” to encourage the voluntary removal of their tents and belongings.
Community advocacy groups, including the Vancouver Area of Drug Users and Pivot Legal Society, have said clearing the encampment violates a memorandum of understanding between the city, the B.C. government and Vancouver’s park board, because people are being told to move without being offered suitable housing.
The stated aim of the agreement struck last March is to connect unsheltered people to housing and preserve their dignity when dismantling encampments.
The City of Vancouver may enforce bylaws that prohibit structures on sidewalks “when suitable spaces are available for people to move indoors,” it reads.
The province is not involved in the fire chief’s order or the enforcement of local bylaws, which prohibit structures on sidewalks, but it is “bringing all of BC Housing’s resources to bear to do what we can to secure housing for people, Rankin said.
“I recognize the profound uncertainty and upheaval people impacted by the fire order are facing, and we will provide updates on this work as we have news to share,” he said.
Rankin, who had been serving as minister of Indigenous relations, was appointed acting attorney general after David Eby stepped down to run for leadership of the B.C. NDP.
This report by The Canadian Press was first published Aug. 12, 2022.
The Canadian Press
N.W.T. RCMP deploy controversial roadside cannabis screening devices
YELLOWKNIFE — RCMP in the Northwest Territories have begun using roadside cannabis-screening technology that has faced criticism from defence lawyers elsewhere in Canada.
Mounties in the territory announced late last month that they had deployed devices designed to take a saliva sample and test for the presence of tetrahydrocannabinol, also known as THC, the main psychoactive substance in cannabis. They said the technology would help them detect impaired drivers and make roads safer.
But some criminal defence lawyers have raised concerns about these devices’ ability to deliver reliable test results, particularly in cold temperatures. They argue the technology isn’t effective at determining whether someone is impaired.
“It can lead to people being arrested who are actually innocent,” said Kyla Lee, a lawyer based in Vancouver.
Lee said research has shown the devices may be more likely to deliver false results in extreme cold temperatures, and movement during analysis could also affect outcomes. She added that while the devices can deliver either a positive or negative test result, they do not indicate how much THC may be in a person’s bloodstream.
Lee recently represented a Nova Scotia woman in a constitutional challenge of the law that allows for roadside drug testing technology in Canada.
Michelle Gray, who uses cannabis for multiple sclerosis, had her car impounded and her licence suspended for a week after she failed a cannabis saliva test at a roadside checkpoint in 2019, even though she passed a sobriety test that same night.
“The technology just doesn’t exist yet to allow police to make a determination of impairment via drugs using physical equipment,” Lee said.
Lee is awaiting a decision on the constitutional challenge in Nova Scotia. She said she expects there will be further court challenges in other Canadian jurisdictions where these devices are used, including the Northwest Territories.
There are two devices approved for roadside cannabis screening in Canada: the Drager DrugTest 5000 and the Abbott SoToxa mobile test system. The companies that manufacture the devices recommend they be used in temperatures no lower than 4 C and 5 C, respectively.
Cpl. Andree Sieber of the Regina Police Service, which began using roadside devices to detect cannabis use in early 2020, said officers bring drivers to their vehicles for testing to prevent issues with weather conditions or temperatures.
“We’ve used it throughout all seasons here in Regina,” she said. “We have very cold winters and some pretty nasty, snowy cold days and you have the person attend back to your vehicle with you where it’s heated and it’s not an issue.”
Sieber said the more THC a person has consumed, the more likely they are to show signs of impairment and to test positive.
The RCMP said roadside screening devices are just one tool they use to detect and investigate drug-impaired drivers alongside officers’ observations. They said field sobriety testing and drug recognition experts remain the primary enforcement tools.
“Police officers rely on what they see and hear, as well as what they smell when investigating impaired drivers,” the RCMP said in a written statement. “Regardless of how a drug is consumed, there are signs of that consumption and police are trained to recognized them.”
This report by The Canadian Press was first published Aug. 13, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
Emily Blake, The Canadian Press
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