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Oct 29, 2015

Juan Carranza presents on advocating for the vulnerable in times of austerity at the recent William Osler diversity conference

Carranza LLP was proud to attend, sponsor and participate in William Osler Health System's Diversity Conference last month, entitled Equity, Ethics and Law in Health Care: Integrating Cultural Considerations into Diverse Clinical Care Settings.

There were around 100 people in attendance, and the discussions focused primarily on treating others how they want to be treated. 

The keynote speaker was Lieutenant Bran Murphy who was the first responder during the Sikh-Temple massacre in the U.S. in 2011 where 6 people were killed. He was shot 15 times and survived and now does a lot of community work in regards to discrimination, bias, stereotypes and racism. 

Juan Carranza presented a talk entitled: Cuts and More Cuts: Advocating for the vulnerable in times of austerity.

He gave a number of statistics*:
  • During the last 30 years economic inequality has risen enormously in Canada Ontario’s Working Poor
  • 695,000 workers who worked in a minimum wage job in 2014.  (up 396% since 2011)
  • A full-time, minimum wage earner doesn’t earn enough to rise above Ontario’s poverty line.
  • 1 in 2 don't have access to a full time job
  • 113,000 working poor in the GTA - families work but don't earn enough to pull their families out of poverty
And poverty affects some more than others - for example, the 2006 Census showed that the overall poverty rate in Canada was 11%.  But for racialized persons it was 22%, compared to 9% for non-racialized persons. In Toronto, 62% of all persons living in poverty were from racialized groups.

Of course, poverty affects many aspects of our lives: access to healthcare, education and housing; as well as incarceration rates, crime rates, school performance, and health outcomes.

Those in poverty who don't have access to healthcare mean inability to fill prescriptions, access needed treatments, physiotherapy, dentistry, eye exams and pay for home care. Of course, disability is both a cause and a consequence of poverty. People with disabilities are twice as likely to live below the poverty line than people without disabilities 

Juan explained that there has been over 50% reduction in rehab funds from $100K to $50K, inclusive of the cost of assessments,unless the victim is deemed to be catastrophically injured. Attendant care has also been reduced over 50% to $36K for the first 24 months and combined with rehab for a total of $65,000 for both - plus the caregiving expense must be “incurred” as per a new definition.

What happens when the funds run out?
  • accident victims’ last recourse is the already stressed publicly funded system
  • go into debt to pay for treatment
  • simply go without necessary rehab or treatment therefore compromising outcomes.
So what can we do? Juan said that one thing is try to meet the definition of catastrophic impairment! The paradox is that to make you better, you must be catastrophic (which is easier said than done - the definition is complex).

But now in 2016, there will be a more narrow definition of catastrophic, therefore it will be more difficult to qualify for catastrophic determination. So what else can we do?
  • Try to get approval for needed treatment plans
  • Make efficient use of rehab funds
  • Avoid unnecessary expenses
  • Explore alternate sources: 
    • Private Insurance coverage
    • Long Term Disability, Medical expenses coverage, etc.
    • Public Disability Benefits
    • ODSP, CPP disability, etc.
And finally, Juan told the conference attendees that in case of injury, we can all help people from falling through the cracks. Consultation with a lawyer to explore legal rights is crucial to have access to needed benefits.

Other presentations at the conference included: 
  • Equity, Ethics, Privacy, Consent, Capacity and the Law in Health: CASE STUDY presented by Patricia Howell M.B.A., B.Sc.OT Reg. (Ont.) Case Manager, Occupational Therapist,  Life Care Planner Neuro-Rehab Services Inc.
  • How Bias Can Impact Health and Health Outcomes presented by Gurwinder Gill, Central West CCAC, Headwaters Health Care Centre & William Osler Health System, Regional Director, Health Equity & Inclusion
  • PAHHR Taskforce (Performance, Accommodation, Harassment, Human Rights) presented by CHRISTOPHER PARKES, GENERAL COUNSEL and PAULA CHIDWICK, DIRECTOR RESEARCH & CORPORATE ETHICS 
  • Consent, Capacity, Privacy: Meeting our obligations presented by Dr. Jill Oliver, Community Ethicist, William Osler Health System

* Sources for the statistics in Juan's presentation: 
Barnes, S. Anderson, L.; Low Earnings, Unfulfilled Prescriptions 2015
Barnes, S.; Lowe Wages, No Benefits, Feb 2015
Crawford, Cameron, Disabling Poverty & Enabling Citizenship: Understanding the Poverty and Exclusion of Canadians with Disabilities.
Making Ends Meet: Toronto’s 2015 Living Wage
National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables.
Personally Speaking: Poverty and Disability in Canada
Pickett, K., Wilkinson R., The Spirit Level
Roche, Hendrickson T., Abban, V., Gaber-Katz; Women Living with Long Term Disability in Ontario, 2015
Snapshot of racialized Poverty in Canada, 2006 Census Canada.
Survey of Labour and Income Dynamics 2011 –Statistics Canada


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