ICBC headquarters in North Vancouver. Mark van Manen / PNG files
VICTORIA — Attorney General David Eby has unveiled the legislation necessary to dramatically overhaul auto insurance in B.C., though in many cases it leaves key details to be decided later by government.
Eby tabled Wednesday the enabling bill required to convert the Insurance Corp. of B.C. to a new, no-fault auto insurance system on May 1, 2021. The 47-page bill in dozens of instances points to regulations yet to be developed by cabinet, and which won’t be debated by MLAs in the legislature, leaving unclear large swaths of details in what is the most significant change to ICBC since its inception four decades ago.
Eby said it was a deliberate strategy to give government flexibility to set the proper benefit levels, rates and rules after meeting with health-care representatives in the coming months.
“It was very important to me and to government that this care-based system be directed by people who have experience in the area, whether it’s practitioners, or as people who have experienced a disabling accident and they’ve had to live with it,” Eby said. “And these are the folks who know best about what benefits should look like, and how they should be delivered. There are questions that need to be answered.”
Wednesday’s legislation is “a framework” for how no-fault insurance will work, said Eby.
“There is a lot of content to the bill and there are key parts in there to provide assurances to British Columbians that what we mean what we say,” he said. “When we say $7.5 million (maximum benefits) that’s in the bill. It’s set out in the language of the law so people know that is a serious thing.”
No-fault insurance means people involved in vehicle crashes can no longer sue for damages — except in cases involving court convictions for offences like negligence, street racing, impaired driving or in cases of faulty manufacturing, botched repairs and the over-service of alcohol by a business.
Instead, people will receive benefits, payments for medical treatment and compensation directly from ICBC, using amounts set by the province depending on the type of injury.
Opposition Liberal critic Jas Johal said the no-fault legislation simply creates a bigger, bureaucratic ICBC where injured people have little say in their recovery.
“This legislation does nothing to address the core challenge facing B.C. residents, which remains astronomical ICBC rates,” he said. “The NDP priority seems to be preserving a 46-year-old state run monopoly, rather than finding ways to dramatically reduce rates.”
The switch will upend B.C.’s litigation-based insurance model, in the process saving ICBC an estimated $2.9 billion in legal fees and pain, suffering and injury claims in 2022. That will result in an average 20 per cent reduction to ICBC insurance premiums in 2021, the Crown corp. estimates.
ICBC said the increase in maximum lifetime benefits to accident victims — to $7.5 million from $300,000 currently — will help those seriously injured get access to rehabilitation, care aides and supports for as long in their lives as needed.
Justina Loh, executive director of Disability Alliance B.C., said she supports the move: “We’re glad that there’s going to be more support and that people can access up to $7.5 million in benefits.”
But she acknowledged not everyone is pleased.
“In the disability community it’s a bit divided, meaning some people are feeling a bit more concerned about the changes,” she said, referencing brain-injury advocates as an example. “Some groups are feeling more concerned, and others are just waiting to see what happens.”
Wednesday’s legislation did spell out a legal “duty” for ICBC to advise people of benefits and ensure they receive all their entitled amounts. However, critics say it’s hard to trust ICBC to provide proper benefits when the Crown auto-insurer is facing immense political pressure to stem its financial losses.
“Minister Eby has made clear, and British Columbians have acknowledged, they’ve lost trust in ICBC, but today we’re being asked to put our lives in their hands,” said Aaron Sutherland, vice-president of the Insurance Bureau of Canada, which represents private auto-insurers. “British Columbians should be concerned about that.”
The Trial Lawyers Association of B.C., which is expected to launch a court challenge against the no-fault legislation, said Wednesday it’s still reviewing details of the bill.
VICTORIA — The ongoing Coastal GasLink pipeline protests have put Premier John Horgan’s government in crisis mode for the past month.
But there is one silver lining for the Horgan administration: The blockades have completely overshadowed analysis of the new provincial budget.
That’s a good thing for the NDP. Because the more you read Finance Minister Carole James’s latest fiscal plan, the more you realize what an uncomfortable document it is for New Democrats to support.
It’s essentially an austerity budget, full of quiet hacks and slashes to programs and services you would never have imagined facing the sword under an NDP government.
James has cut funding for public transit, civilian-led police investigations, food inspection, environmental protection, parks, conservation officers, forestry enforcement, First Nations initiatives, international trade, small business, mental health policy and research, road safety, tourism, anti-racism and hate speech prevention programs, multiculturalism and sports.
The figures are buried deep within the line estimates of the budget itself, and conveniently never mentioned in the many pages of semi-factual government communications material.
“Budgets are about choices,” James told reporters at the Feb. 18 budget lockup.
“It’s about taking a look at the resources we have, and the priorities that we have as a government. I think if you had taken a look at the past governments what often would happen at this time, when you saw moderation in the economy, is that you would see programs and services cut. You would see programs eliminated. You would see services and supports for families eliminated. We’re not doing that.”
James is on year two of mandatory cuts across all ministries, to achieve $300 million in annual “discretionary” spending.
What’s been trimmed so far? James and her ministry won’t produce a list, insisting it’s hard to track because the money goes back into services (despite the fact each ministry is required to submit to her a clearly itemized list of potential cuts and consequences).
Still, you can spot the cracks in the facade.
B.C. Transit has warned about a stall to ridership growth after government shrunk its operating grant. James told transit to draw from its operating surplus to make up for the changes. By next year, what was once a $42-million financial cushion against any unexpected changes to bus service levels will be gone, as B.C. Transit empties its piggy bank to help the NDP balance its budget.
What are the other implications of the budget?
Safety inspections for meat, seafood and agri-food products cut by almost 12 per cent.
RoadSafetyBC, which runs traffic safety programs and monitors unfit drives, cut three per cent cut.
The civilian-led Independent Investigations Office that oversees death and serious injury cases against police cut three per cent.
Environmental protection, air and water quality monitoring, managing pesticides and responding to high-risk environmental emergencies cut three per cent.
BC Parks maintenance cut two per cent, and conservation officers patrolling those parts cut two per cent.
Forestry enforcement cut six per cent.
International trade cut seven per cent (but, presumably, not overseas trade junkets by cabinet ministers).
Small business, immigration and refugee worker programs cut 2.4 per cent.
Tourism, arts and culture cut 1.5 per cent.
Anti-racism and hate speech prevention programs, along with creative economy funding, multiculturalism and sport cut two per cent.
Some of the reductions are particularly jarring, given James’s own budget speech.
“We know that delivering on these priorities means strong climate action, meaningful reconciliation with Indigenous peoples and a commitment to equity, diversity and inclusion,” she said.
What then to make of a 13 per cent cut to B.C.’s “climate action” program that “provides support for the activities required to meet the province’s climate action target”? Those targets are supposed to be met by the government’s new CleanBC plan, which is a centrepiece of the NDP-Green power-sharing deal. If that worried the Greens, and independent MLA Andrew Weaver, they didn’t show it — all three voted in favour of the budget Thursday.
Then there is the ongoing reconciliation crisis with First Nations, sparked by the pipeline protests. For some reason, the government chose this year to cut the Ministry of Indigenous Relations and Reconciliation by almost 10 per cent.
Horgan admitted to reporters Thursday his government has more to do to improve mental health and addictions. But his government shaved almost five per cent off the division in charge of researching and growing new mental health and addictions services.
It’s true the budget does offer small inflationary increases to cover caseloads in social services, disability, child welfare, education, and elsewhere. Health care, as usual, got the biggest lift. And there’s just enough cash for affordable housing and $10-a-day child care plans to keep them on their 10-year-long implementation schedules.
The money wasn’t enough to avoid criticism from community groups that the province continues to underfund victims of crime and sexual assault survivors. Long-time NDP supporters who wanted to see an increase to social assistance, disability and shelter rates were also left disappointed.
Overall, it was the kind of budget that could have been written by the previous B.C. Liberal government during its heyday of prudence, caution and austerity.
James did have a choice.
With the economy softening, and international uncertainty rising, she could have dipped the budget into deficit to continue funding the NDP’s ambitious election promises and social programs.
The result is a budget full of cuts that would be toxic for the NDP to take to voters in an election campaign. Perhaps the biggest take-away from the whole exercise is that Horgan must be extremely confident he’s not going to the polls this year.
Luckily for James, she’s got one more budget before the next election.
Expect that one to miraculously open the floodgates of spending in all areas, washing away the bitter taste of this year’s cuts and clawbacks to government services. Then, the NDP will put this Liberal-lite austerity budget on the shelf, and never, ever, speak of it again.
There was some good news in the 2019 data from the B.C. Coroners Service. Overdose deaths in the province declined for the first time since fentanyl-tainted drugs hit the streets and a public health emergency was declared in 2016.
The decrease was significant — down 36 per cent from 2018 — even though the death toll remains heartbreakingly high. As B.C. enters its fifth year of the crisis, nearly three British Columbians are dying every day.
It does mean that all of the money poured into this crisis — for naloxone kits, the training for paramedics, medical professionals and laypeople in how to use naloxone, more supervised consumption sites, and more people now on prescriptions for drugs like methadone and Suboxone to staunch addicts’ opioid cravings — is keeping more people alive.
But that’s really where the good news ends.
Alarmingly, the number of 911 calls has continued to climb.
Paramedics and other first responders took more than 24,000 calls last year, with calls spiking to more than 130 overdose alerts on “cheque days” or “welfare Wednesdays.”
Being revived from an overdose or living with an opioid addiction comes at a high cost.
Opioids affect the receptors in the brain, causing breathing to become dangerously slow, which in turn slows the heart and sometimes causing cardiac arrest. When the hearts doesn’t pump at capacity, less oxygenated blood makes it to the brain. Without oxygen, brain cells die — and they don’t regenerate.
It’s called toxic brain injury.
Within the coming weeks or months, the B.C. Centre for Disease Control will release data on the prevalence of brain injury among opioid users, including those who have been successfully restored to life with naloxone.
“We know that many hundreds of people will need a lifetime of care,” said Dr. Perry Kendall, who raised the alarm during the coroner’s news conference earlier this week. “It will be a tremendous burden.”
It’s far from the only one.
The burden carried by first responders is different and no less costly. They are burning out and checking out of the system, unable to cope physically, mentally or emotionally with the constant stress of being called to deal with all the overdoses.
This is not to say that harm-reduction measures aren’t working. No one disputes that they are keeping many people alive.
But until now, little attention has been focused on the quality of their lives, post-overdose.
Five years into the public health emergency, Chief Coroner Lisa Lapointe said B.C. still doesn’t have a comprehensive system that includes prevention, treatment and recovery.
The lack of a seamless system is particularly problematic and even deadly for people in rural areas and those coming out of jails and prisons, according to Dr. Nel Wieman, senior medical officer at the First Nations Health Authority.
The numbers back that up. The death rate in the Northern Health Authority, at 22.5 per 100,000, trails Vancouver Coastal, which has the highest rate, by a mere half a percentage point.
Regardless of where they live, Lapointe said families frequently tell coroners how their loved ones managed through detox only to come out and die while on the waiting list for a recovery bed.
The problem isn’t necessarily that there aren’t enough treatment beds. On most days, some lie empty because the government only funds treatment for welfare recipients. Everyone else has to pay their own way. And except for those with generous employee benefits, many can’t afford treatment that comes at a cost of $900-plus a day.
Lapointe also decried the lack of provincial treatment standards. Different operators have different approaches. Some aren’t evidence-based. Some are strictly abstinence-based and refuse to accept people on drug therapies such as methadone and Suboxone, even though without that, they are more vulnerable to overdose if they relapse.
Decriminalization is touted by some as the answer. Without fear of criminal charges, the theory is that people would be more willing to seek help.
They point to Portugal, where decriminalization was brought in as part of a massive overhaul of its drug treatment system.
But decriminalization has only worked there because Portugal also boosted spending on the other three pillars — prevention, enforcement and treatment.
Here, the crucial elements are missing. With a minority government in Ottawa, the Liberals already have enough problems on their plate to risk raising the controversial idea of decriminalization.
Meanwhile, most provinces, including B.C., haven’t invested enough in the infrastructure to put a Portugal-style model in place.
This week, Mental Health and Addictions Minister Judy Darcy agreed that there are enormous gaps in B.C.’s fragmented system.
When the New Democrats were elected less than three years ago, she said the drug treatment system had been neglected for so long that it was not able to cope with regular tasks, let alone a public health emergency.
The government is taking steps to fix that. But whether it’s moving fast enough is a conversation that both the coroner and chief medical health officer are pushing British Columbians to have because the lives of many loved ones depend on it.
BURNABY October 24 2019. The ICBC Claim Centre at 4399 Wayburne, Burnaby, October 24 2019. Gerry Kahrmann / PNG staff photo) 00059159A [PNG Merlin Archive] Gerry Kahrmann / PNG
Groups affected by the Insurance Corp. of B.C.’s move to a no-fault system say they’ll be scrutinizing the change closely following the government’s surprise announcement.
John Rice, president of the Trial Lawyers Association of B.C., said he was “deeply disappointed” by the move. The association will be investigating whether the proposed reforms should be challenged in court.
“You’ll remember that just in the spring of last year this government introduced sweeping legislative changes that contemplated the concept of a cap on what the government promised would only be minor injuries,” he said.
“But in fact, that cap included brain injuries, depression, PTSD, chronic pain … really serious stuff. And only nine months into this new law, government is effectively announcing that the policy scheme that they have pursued for the last two years has failed.”
Rice said the government changed the policy out of the public eye, so the legal community was in the dark when it made its announcement Thursday. His association is now looking closely at the proposed reforms and considering its next steps.
“If the government and the attorney general of British Columbia have passed a law that in the view of constitutional law experts is unconstitutional, then it’s the mandate of the Trial Lawyers Association of British Columbia — its mission — to protect the rights of British Columbians against anyone, including our own government,” Rice said.
However, several provinces already have no-fault insurance.
Rice said successive failures by government have meant that it has taken the once-profitable “crown jewel of public auto insurance in North America” and put it in crisis.
“Their solution is to create a much bigger fire in a much bigger ICBC dumpster,” he said.
Justina Loh, executive director of Disability Alliance B.C., said her organization is hopeful about the reforms and will be consulting with ICBC to make sure its regulations and policies don’t prevent people from getting the benefits they need.
Loh said the alliance wants to see a streamlined, efficient system so that support is not delayed.
“At the end of the day, we just care about the well-being of everyone, people who’ve suffered any type of injury for motor vehicle accidents, if they’re pedestrians, cyclists, anything like that,” she said.
“We just want to make sure they’re able to get all the support that they need, so not just physical support for OT (occupational therapy) or PT (physical therapy), but if they need support for housing, for transportation. There’s so many expenses that you can incur from either a catastrophic accident or some type of motor vehicle accident.”
Aaron Sutherland, vice-president for the Insurance Bureau of Canada’s Pacific region, said that just because a province chooses a no-fault system, it doesn’t mean drivers shouldn’t have a choice in who insures them.
“Whether it’s a tort system like today or a no-fault system that government has announced, the big thing to make sure that rates are affordable as they can be is to make sure drivers have a choice,” he said.
Sutherland pointed to Quebec’s hybrid coverage method, where a mandatory public insurance plan covers bodily injury, and in some cases physical damage, such as hit-and-run, while all other coverage, including property damage, is purchased from private insurers.
The average insurance premium there is just $717, he said.
“We currently pay more for auto insurance than anyone else in the country and while it’s great to hear projections that rates are going to be coming down, I think we have to wait to see what ultimately happens,” Sutherland said.
“I think just last year government introduced a whole bunch of other reforms that were supposed to improve rates. And, of course, that didn’t happen.”
The UGM has a long, respected record of providing supportive recovery housing for people with addictions, including this one, The Sanctuary, for women. Yet it is on a government list of “unlicensed” operators. Blame the government’s confusing and opaque rules. Jason Payne / PNG
For 80 years, the Union Gospel Mission has provided services in Vancouver’s Downtown Eastside, feeding people, providing shelter and helping them deal with addictions.
It has annual revenue of just over $22 million and assets of nearly $7 million. A couple of weeks ago, it served 2,500 people at its annual Christmas dinner.
It is one of the largest providers of supportive recovery housing for people with addictions.
For women, whose needs are greatly underserved, UGM has the eight-bed Lydia Home in Mission and 13 beds at The Sanctuary on Heatley Avenue in Vancouver.
For men, it has a purpose-built facility with 62 beds for addictions recovery, 72 shelter beds and 37 affordable housing units that opened in 2011.
The provincial government put up $12.1 million for the $29 million facility and the city waived $420,000 in development fees, which explains why former housing minister Rich Coleman and then-mayor Gregor Robertson were among the dignitaries attending.
Clearly, UGM is no fly-by-night organization.
But it’s a testament to the complexity and opacity of the B.C. government’s assisted living registry that UGM has found itself on a list on of 26 unregistered (a.k.a. illegal) facilities, which includes both supportive addictions recovery houses and seniors’ assisted living.
“We feel terrible and embarrassed about our mistake as we take regulatory compliance seriously,” programs director Dan Russell said in an email. “We believed our recovery programs did not require registration or licensing because we did not provide any prescribed services.”
When UGM learned that its recovery program “could be interpreted as a therapy program” under the Community Care and Assisted Living Act, Russell said it immediately contacted the Health Ministry, which sent inspectors on Oct. 10.
In their report posted on the ministry’s website, the inspectors listed two prescribed services that were being offered at all three houses as “psychosocial supports and medication administration.”
UGM was ordered to reduce the number of people receiving services to no more than two at each location, cease providing the services or immediately apply for registration.
UGM sprang into action, gathering documentation to meet all 30 requirements on the registration checklist. It was ready to submit the application on Nov. 20. But by then, the online application form had disappeared because of new regulations that came into effect Dec. 1.
It meant UGM (along with any others attempting to get off the bad list) had to gather more documentation to prove that it meets the new guidelines. UGM is still working on completing it, but it had hoped that its good intentions would have meant it would be taken off the list.
Among the many reasons that UGM is so eager to get off a list is that the list includes several very bad operators.
Those bad actors are the reason that after years of inaction, the province has finally taken some steps to strengthen regulations and enforcement to protect vulnerable addicts searching for help.
Vancouver Recovery Centre is one of those. Operated by Kyle Walker, four of its houses are on the unregistered list with complaints against them.
The Abbotsford News reported that neighbours of the one on Eagle Street in Abbotsford described it as a flophouse when they went to city council meeting in May to finally get it closed.It also reported that police had been called to the house 32 times between January 2017 and January 2019 for a sexual assault, a domestic dispute and threats and that residents were being charged $800 to live there.
The house was still operating despite orders from the city in April 2017 and the province in September 2018 to close.
For decades, the provincial government and municipalities have been playing whack-a-mole with scammers who promise addictions recovery services and provide only shelter.
Yet, even some government-registered recovery houses have critical failings — failings that have cost five people their lives in the past year.
Union Gospel Mission is not one of those and there are many registered and licensed houses operating to the highest standards.
Protecting them from guilt by association is why registration, licensing, regulation and enforcement are all crucial.
More importantly, a robust system and a credible registry are only ways that anyone — let alone desperate addicts and families — can determine whether a recovery house is safe or whether the best thing about it is a slick website.
Soon British Columbia will mark the fourth anniversary of a public health emergency caused by overdose deaths from a fentanyl-laced supply of illicit drugs.
The number of deaths dropped 30 per cent in the first half of 2019. But the number of times paramedics were called to deal with overdoses remains near its all-time high.
Addiction isn’t going away nor is the need for high-quality treatment and recovery services.
If ever there were a need for more harm reduction, it’s at the registered and unregistered, licensed and unlicensed addictions recovery houses in British Columbia run by operators who have no regard for residents’ health or safety.
Within the last year, five people have died in provincially registered recovery homes. Two of those deaths were in the last three months.
On Dec. 1 — years too late for too many — new legislation and regulations finally came into effect. But they apply only to operators on the provincial Assisted Living Registry and not to those licensed by the local health authorities. There is also no provision to shut down those that are operating illegally. On its website, the Health Ministry does list 26 unregistered houses that it has received complaints about. But people in the recovery community say it’s only the tip of the iceberg.
The regulations themselves are “thin,” according to Carson McPherson, the chair of the B.C. Centre on Substance Use’s recovery committee.
“They’re easy to work around. There’s no real specificity anywhere,” said McPherson.
“There are no specific requirements for level of staffing qualifications tied to prescribed services. If you’re delivering trauma-informed services, you ought to have someone qualified. But that doesn’t exist (in the regulations).”
Prior to the regulations coming into effect, the Addictions Ministry provided $4,000 grants to operators for 16 hours of staff training.
But McPherson argues that’s hardly enough. “You’re dealing with health care and life and death situations.”
Beyond that, what’s been left in place is a confusing system that’s almost impossible for recovering addicts and their families to navigate. While some recovery houses are registered on the province’s Assisted Living Registry, others are licensed by local health authorities.
Still others operate illegally, which has forced municipalities like Surrey to use their limited business licensing and bylaw enforcement systems to try to shut them down. The government provided no new tools or authority to deal with those.
Despite that, there’s plenty of catch-up work that B.C.’s assisted living registrar needs to do.
Until now under the old, so-called “progressive system,” registered operators were given multiple chances to fix problems and there were no consequences if they didn’t.
On Nov. 26, for example, it cancelled Step by Step Recovery Society’s registration. But two days later, a man in his 30s lit himself on fire and died at one of its five Surrey houses. He was the third resident in less than a year to die in one of Step by Step’s houses, which had 65 substantiated complaints registered against them.
Even now, at least one of its houses remains open. The Addictions Ministry says it has asked the city to help the remaining residents find spots at other recovery houses.
Why wasn’t Step by Step immediately closed on Dec. 1 when the legislation and regulations came into force? Because they’re not retroactive and the actions begun against Step by Step are covered by the old rules.
Also exempt from the new regulations areOptions Recovery Centre in Surrey and Reaching Out in Vancouver where the two other deaths occurred earlier this year.
On July 1, a beloved young man died at Options on 100A Avenue. The 24-year-old was the brother of a friend of mine.
Among the most cynical of Options’ substantiated failings is that it failed to even meet the legislated requirement of filing a serious incident report to the registrar within 24 hours of his death. It was only reported on Aug. 8 after complaint had been filed.
But that was the only substantiated complaint to which John Alan Murphy, Options sole proprietor, has responded.
Investigators have substantiated complaints that it fails to provide many of the key services required of supportive addictions residential care homes.
In July, investigators found that staff and volunteers are not qualified for their jobs or knowledgeable about their roles.
No help is provided for residents to work toward long-term recovery, maximize their self-sufficiency, enhance their quality of life or help them reintegrate into the community. The food was deemed not to be nutritious or safely prepared.
Two months earlier, investigators substantiated a similar list of complaints.
Unsafe meals. Unsafe site management. Unqualified staff and volunteers. No support to assist in recovery and reintegration.
Sometime in September, a resident died at Reaching Out, a house in Vancouver operated by Changing Addictive Attitudes Recovery Society of B.C.
On Nov. 25, investigators substantiated complaints about Reaching Out that are chillingly similar to those at Options.
Reaching Out failed to report the death at its facility within 24 hours. Staff and volunteers were unqualified. There is no 24-hour emergency response system for residents and staff to summon help. And investigators deemed it an unsafe place for residents to live.
To gain some modicum of credibility, the registrar needs to act swiftly to bring all of the houses into line and hope that no one else dies in the meantime.
As for Health Minister Adrian Dix and Addictions Minister Judy Darcy, they ought to draft even more sweeping changes, bolstering enforcement to ensure that illegal operators can also be rooted out.
Vulnerable people aren’t just dying on Downtown Eastside streets in the midst of the opioid overdose crisis. They’re dying in places that promise to help them attain a healthier lives.
Anyone who provides assisted living services for more than two seniors, people with mental health issues or those in recovery from addictions is required to be approved by B.C.’s assisted living registrar. Following is a list of unregistered homes by region fromhttps://connect.health.gov.bc.ca/ext/ccala/assisted-living
• 3H Wellness Society
13297 78A Avenue
• A:yelexw Women’s (Seabird Island Recovery Homes)
Shane Simpson, Minister of Social Development and Poverty Reduction, at a community consultation session for new accessibility legislation in Vancouver on Nov. 2, 2019. Gerry Kahrmann / Postmedia News Files
As the B.C. government develops accessibility legislation, a left-wing think-tank is calling on policy-makers to consider how historical injustices and continuing discrimination have led to a society that still excludes the deaf and disabled.
From Sept. 16 to Nov. 29 of this year, the Ministry of Social Development and Poverty Reduction collected public feedback to help develop the new legislation it says will “guide government, persons with disabilities and the broader community to work together to identify, remove and prevent barriers.”
A framework shows how the legislation could work by including standards for service delivery, employment, information, communication and transportation. Minister Shane Simpson said he wants the legislation tabled in the fall of 2020.
The Broadbent Institute commissioned consultant Gabrielle Peters for its submission, which she said is focused on justice and rectifying decades of oppression and discrimination.
“I wrote this because we’re doing it wrong,” said Peters, a Vancouver writer with chronic health issues who uses a wheelchair.
“We have to change how we think about accessibility. We have to change who we think about in terms of accessibility, in order to start doing it right.”
The Broadbent submission first discusses the historical impacts of colonialism, eugenics, institutionalization and sterilization on deaf and disabled Canadians.
It then looks at how those experiences have led to deaf and disabled people being disproportionately represented among the poor, homeless and as victims of violence. They are excluded from education, employment and public and community life, and face barriers in the health care system, the submission says.
“Nearly half of all Human Rights complaints (49 per cent) in Canada are disability related,” Peters wrote. “Discrimination against disabled people is rampant while simultaneously being almost entirely invisible in the public discourse about discrimination.”
Broadbent makes 16 recommendations it says will help repair that damage, the first being the legislation should consider the phrase “nothing about us without us” by including “deaf and disabled British Columbians” in its name.
“Decisions about what was best for disabled people made by the province’s respected leaders resulted in the worst outcomes and a shameful period in this province’s history,” Peters wrote. “This new legislation must spell out whom it is for and what it is intended to begin to rectify and prevent.”
The second recommendation urges government to write legislation that goes beyond making B.C. “barrier-free,” and works to fight oppression. It recommends that government name ableism as the source of systemic oppression of disabled people and the cause of inaccessibility.
The third recommendation calls for the legislation to be intersectional. This would mean recognizing that class, race, religion, ethnicity, sexual orientation, gender identity, and other aspects of a person’s identity and life experience are linked to various other systems of oppression that marginalize disabled people and make parts of B.C. society inaccessible to them.
The full submission can be read at broadbent.ca. Peters said she hopes it shows to readers that accessibility “isn’t a gift” to be handed to deaf and disabled people, but a human right that they’ve been denied.
The submission also features contributions from harm reduction policy specialist Karen Ward and from urban planner Amina Yasin, who write about racism, ableism and the built environment.
Maria Dobrinskaya, B.C. director for Broadbent, said the submission’s justice-based approach could guide other ministries in their approaches to housing policy, municipal bylaws, transit and other issues.
Government may choose not to implement all 16 recommendations, Dobrinskaya said. But she is pleased the submission will reach the desks of Minister Simpson and other policy-makers, adding that “it’s important that it’s on the record.”
“I think it is very broad in its scope,” she said. “I’m hopeful though, that the comprehensive nature of the approach that we took helps to inform more specific focus on policy that the ministry will be looking at.”
The federal government passed Canada’s first national accessibility legislation in May, meant to “identify, remove and prevent” accessibility barriers in areas that fall under federal jurisdiction. Those include built environments, federally run programs and services, banking, telecommunications and transportation that crosses provincial lines.
That legislation, however, doesn’t address barriers within provincial jurisdiction. Manitoba, Ontario, Quebec and Nova Scotia have passed accessibility laws, and Newfoundland and Labrador are developing their own, too.
But B.C. — where more than 926,000 people older than 15 have some form of disability — has lagged behind.
Tamara Loyer proudly wears a bright red lanyard around her neck, from which dangles keys to the modest office where she oversees a unique Downtown Eastside drop-in program for trans woman that she designed this year.
She’s come a long way in the past decade: from a despondent homeless woman trapped inside a body with male genitalia to someone who has undergone gender-confirming surgery and now has a home, goes to school and is employed.
“I’ve not been in an office setting since the mid-1980s,” laughs Loyer during an interview at Atira Women’s Resource Society, where she started the Beyond the Street drop-in for trans women in September.
Now 57, Loyer believes her internal war with her gender was at the root of her 30-year spiral into drug addiction, sex work and homelessness, and that the surgery she had in April 2014 gave her the confidence to start putting her life back together again.
“After surgery, I thought I don’t want to have to think about (gender) the way I did before. I can be part of the world. I can go and do things now without being self-conscious,” she reflected. “I walk around here and I don’t have to be afraid that what’s in my head and what people see aren’t the same.”
She is happy with her outward appearance, but is inwardly still haunted by gender dysphoria — a crippling unhappiness with one’s biological gender.
“After surgery, we all like to think that it will never bother me again. It still does. I think about it every day,” she said.
Her dark thoughts are often triggered by still-lingering male gender traits, such as facial hair and a low voice. “That bothers me still to this day. I’m not as critical, as I was, at what I see in the mirror, (but) it doesn’t go away 100 per cent.”
The Vancouver Sun documented Loyer’s story in 2014: the challenges of applying for the surgery and organizing the logistics when you have a vulnerable lifestyle, no fixed address, a panhandler’s income, and no family supports. At the time, B.C. funded sex-reassignment surgeries, but the only place in Canada that performed them was a private Montreal hospital, where Loyer was flown by a charity airline.
“I had nobody with me and it was terrifying,” she said. “It was daunting. There is so much red tape to go through.”
The number of B.C. patients that must endure that flight to Montreal is expected to decrease in the coming years. A new gender surgery clinic opened in Vancouver General Hospital in late September, where the Health Ministry anticipates full-scale gender-affirming surgeries will be performed, likely next year.
B.C.’s new gender surgery clinic
Two surgeons with specialized skills have been hired to work at the clinic, and since September have done repairs and revisions to previous surgeries, and performed parts of so-called “lower surgeries” — but not yet the entire procedure, the Health Ministry said in a statement.
Until this year, patients in every province had to travel to Montreal for “lower surgeries” — which include vaginoplasty for trans women and phalloplasty for trans men. In June, Ontario started to offer these complex surgeries at Women’s College Hospital in Toronto, and B.C. plans to be the next province to do so.
“The trans community has advocated over a number of years for improved access to care, including access to complex lower surgeries within B.C.,” Health Minister Adrian Dix said in November 2018, when he first indicated the services offered here would expand.
“For those seeking lower surgery, people were required to travel to Montreal or to the U.S., resulting in additional medical risks associated with travelling long distance after surgery and in receiving followup care if there were complications.”
The number of British Columbians travelling to Montreal has been on the rise, with about 100 patients annually in recent years. That number is expected to stay roughly the same in 2020, while the B.C. program fully ramps up, the Health Ministry said.
An estimated one per cent of the population identifies as trans, which includes a wide range of people for whom their gender is different from their assigned sex at birth. In B.C., the Health Ministry says, about 46,000 people identify as “trans or gender diverse,” but only a few will pursue medical or surgical services.
Offering the service closer to home will make it simpler to access and to allow friends to visit during recovery. That may encourage more trans people to consider surgery, especially those from marginalized communities like the Downtown Eastside, Loyer said.
And, she argued, it will benefit society in the long run to help more people feel in sync with their own bodies.
“You are going to get a person who is going to be more productive. Somebody who might want to go to school, get a job. Somebody who might want to join their family again,” she said. “You don’t have to live in despair, overwhelmed with what is described as an illness. You can be functional.”
Trans people face discrimination and harassment, which often leads to poor mental health and a greater risk for suicide, says the Calgary-based Centre for Suicide Prevention.
Loyer speaks softly when she remembers trans friends who committed “suicide, got killed, ran away, were never seen again, overdosed or became mental patients.” She hopes these tragedies will be less frequent among her peers with the new local access to medical help.
Another set of surgeries many trans people pursue — breast augmentation or chest construction — were, until recently, offered in only Vancouver and Victoria. Now B.C. has 16 surgeons who do this work, and these procedures have been extended to Abbotsford, Burnaby, Port Moody, New Westminster, Kamloops, Kelowna and Prince George.
The demand for these upper surgeries in B.C. has quadrupled in just three years, with 49 performed in 2015-16 and 254 in 2018-19. The Health Ministry anticipates 300 breast or chest surgeries will be completed by the end of this fiscal year, in March 2020.
And B.C. has a waiting list for this procedure with more than 200 names.
In 2015, the Provincial Health Services Authority launched Trans Care B.C., which offers details about health care and support for trans people or their families. Its service directory lists dozens of drop-ins and information groups across the province, including in communities outside Metro Vancouver such as Prince Rupert, Fort St John and Cranbrook.
She hoped B.C. would offer acceptance
So much as changed since Loyer first arrived in Vancouver in 1984, at age 23, leaving behind a turbulent childhood on a Quebec military base. She came here to seek acceptance. She assumed the name Tamara, found work as a computer programmer and continued to pursue post-secondary education.
But she faced discrimination, numbed her pain with drugs, and eventually worked the streets to earn income. In 1989 she began inquiring about a sex-change operation, but had no stability to pursue surgery.
She was homeless, sick and dejected in 2011 when an outreach worker took her to the first place she felt at home: a shelter for woman, run by Atira. Despite the obvious challenges of sharing communal bathrooms with the female tenants of the modest shelter, Loyer began to heal and, through a new network of support, was able to get her surgery in March 2014.
The Healthy Ministry paid $20,000 for the procedure and $2,000 for her post-surgery care in Montreal. Doctors removed her male organs and created a vagina.
The Vancouver Sun’s first feature on Loyer was published one month after the operation, when she was still healing and had modest ambitions to live a more stable life.
Today, she says that it took her about six months to physically heal from the invasive surgery while she lived in Atira-supported housing in the heart of the Downtown Eastside. There were infections that required cleaning, extreme tenderness, and a daily routine of using dilators to ensure her new vagina wouldn’t close up.
And there are post-operation steps that will be necessary indefinitely. Attached to her stomach is a patch that supplies very large doses of estrogen, a female hormone that her body considers a foreign substance and tries to reject.
But, overall, she is elated with the outcome of the surgery. “I wake up in the morning and I’m happy that I don’t have to encounter a body that is what I had. That was one of the most horrible things in the shower and the washroom and getting dressed. And that is gone.”
Loyer does not wear makeup, jewelry or fancy clothes, but rather prefers basic, gender-neutral garb.
“I am happy with what I look like,” she said. “It’s not the outside that’s the problem. It’s the inside that is giving me the problems.”
In early 2019, Loyer was upgrading her high school credits at the South Hill Adult Education Centre in south Vancouver, but she was also still panhandling, which she found increasingly demeaning, to supplement her disability pension.
“I didn’t want to be there. I wanted to be in school.”
Loyer appeared “isolated,” recalled Janice Abbott, the executive director of Atira, so she suggested Loyer open a drop-in for trans women. Atira offered space to hold the meetings, a small budget for food and communication, and the encouragement for Loyer to independently create a program that was needed in the Downtown Eastside.
“The trans community is complex, it’s not homogeneous in any shape or form. So I think that more opportunities for safe space in ways that trans women identify their own communities, I think that there needs to be more (of) that,” said Abbott, adding that Loyer’s drop-in is a low-key environment where people can make friends and share challenges.
“I think everyone in the Downtown Eastside needs an informal place, where you don’t have to come in and fill out a form that says I need social services. It’s a place to get a snack and have a cup of coffee and hang out for a couple of hours. And I think that’s part of what makes it beautiful.”
Beyond the Street trans drop-in
Loyer’s program, Beyond the Street, is among the first peer-led drop-ins for trans women in Vancouver. It has been holding two-hour sessions every Sunday afternoon since September.
It focuses on offering people help in three main areas: housing questions, such as dealing with transphobia while looking for an apartment or getting evicted; legal matters, such as how to change your name or marriage breakup help; and counselling issues, such as being trapped in a lifestyle that isn’t true to your identity. The program also offers fun activities like Thanksgiving dinner and movies.
“Sometimes trans women get stalled. Something happens and you stop. You can’t get anywhere, whether it’s housing or medical. The idea is to keep them going,” said Loyer.
The three-month-old drop-in has 12 regular attendees, but Loyer also helps women in other communities by phone or email.
She hopes the program can offer marginalized trans woman better options than they often faced in the past: “You end up on the street corner, or you end up in the alleys, or you break down and cry, or you suicide.
“We try to keep people from saying, ‘Oh well, this is what I get.’ Which is easy to think when you don’t have anybody saying anything different,” Loyer said.
Among Atira’s many social housing buildings, which accommodate more than 1,500 women and children every year in the Lower Mainland, up to 20 per cent of the adult female tenants identify as trans, depending on the building type and location, Abbott said.
Many trans women also use Atira’s SisterSpace, which is described as the first women-only overdose prevention site in Canada. Evaluation reports on Atira’s website quote trans women who say the “safe space” offers empathetic workers and an escape from transphobia.
Trans issues have increasingly been in the news. In a high-profile court case, a local father who opposes his transgender child’s pursuit of testosterone therapy fought lower-court decisions all the way to the B.C. Court of Appeal.
For Loyer, trans issues are not new. They’ve been bottled up inside of her for five decades. She hopes, though, that more attention will lead to increased acceptance.
Since her surgery in 2014, she said, her health has improved drastically. The hepatitis C she contracted in 1989 from intravenous drug use is now not detectable in her blood. She is drug-free and quit her 30-year smoking habit. She can walk without a cane, which she had used since her leg was broken in a nasty 2011 assault. Her sight has improved after a hole in her cornea, likely from a beating, was repaired. And she now weighs 165 pounds, up from the 109 she weighed when she arrived on Atira’s doorstep nearly nine years ago.
She no longer lives in supported housing, and has moved to a mixed-income Atira building where many of her neighbours have jobs and go to school. While B.C. Housing subsidizes her rent, Loyer must pay for utilities, internet, and other living expenses.
Perhaps she is most excited about the high school science and math courses she is taking to boost her marks so she can one day apply to the University of British Columbia for a combined degree in astronomy and physics. A downtown investment firm, who read about Loyer in 2014 in The Vancouver Sun, has told her it will pay for her tuition if she gets accepted to UBC.
But with that excitement also comes the fear of failure.
“I need to find a place to apply myself. But the science part I was really nervous about. I didn’t want to think that I could do something and find out that I made a total mess of it and lose confidence,” she said.
Loyer will need confidence to complete her academic goals. She has displayed confidence already, though, in the pursuit of her gender goals. And she has a favourite saying that has, in the past, given her courage and determination: It’s a song title from the movie The Rocky Horror Picture Show, which she saw in Toronto in 1978 after she ran away from home, at age 16, so she could start living as a woman.
Late last month, a man in his 30s with a long history of addiction doused himself with gasoline and set himself on fire in the garage of a Surrey recovery house.
Two other residents went to hospital and were treated for smoke inhalation as a result of the two-alarm fire.
The B.C. Coroners Service is investigating. So is the Surrey fire department.
Self-immolation is tragedy enough. But what makes it worse is that the man’s death is directly attributable to years of appalling neglect. For two decades, B.C. failed to regulate residential addiction treatment facilities or ensure that they met even the most basic standards.
The man, who has not been officially identified, died in a government-registered treatment home where he was supposed to be monitored, supervised and helped to attain long-term recovery.
What intensifies the tragedy is that his was the third death in a year in a house run by Step by Step Recovery Society. One of the society’s five directors, Debbie Johnson, owns the house at 138A Street that was badly damaged in the fire.
Between November 2018 and March 2019, there were 65 separate breaches of the Assisted Living Registry’s regulations at the five Surrey houses that the society was operating.
Those infractions — the most recent of which were investigated in March — range from inadequate food to unqualified staff to unsafe facilities to failure to ensure residents are not a danger to themselves or others.
At the house on 138A Street where the most recent death occurred, there were 11 substantiated complaints. Only one was dealt with, according to the most recent report posted on the Assisted Living Registry’s website.
The pest control people did get rid of the mice.
But, according to the report, no action had been taken to address verified complaints about safety, about untrained, unqualified staff, and about the lack of any psychosocial supports aimed at helping people attain long-term recovery.
The society voluntarily closed two of its houses earlier this year.
But of the three still on the registry, all have substantiated complaints that haven’t been dealt with. In March, nothing had been done at the houses on 78A Avenue and 97A Avenue that were deemed unsafe for the needs of residents. Verified complaints posted in February about safety and the quality and training of staff remained outstanding.
The question that screams for an answer is: Why wasn’t Step by Step shut down earlier?
The legislation didn’t allow it. The Assisted Living Registry had no power to take immediate action to suspend or attach conditions to a registration.
Instead, all that the registry staff could do was try to work with the operator to get them to conform.
There are dozens of other niggling questions. If this were a well-staffed facility, someone might have realized that the man was struggling before he went to the garage. If it were a well-run, supportive house, it’s unlikely he would have had access to gasoline.
With better rules and oversight, those other two deaths at Step by Step might not have occurred either, and maybe other deaths could have been avoided over the past two decades.
Two decades. That’s how long B.C. went without any regulation of residential treatment centres.
That finally changed on Dec. 1 — 21 years after a previous NDP government brought in regulations only to have them scrapped in 2001 by the B.C. Liberal government that described them as too onerous.
The Liberals did promise new and improved rules in 2016 after a Surrey mom was killed outside a hockey arena by a resident of one of the unregulated facilities. But those rules were never enacted.
In 2017, a coroners’ jury recommended regulations following a 20-year-old man’s overdose death in a Powell River treatment centre. Those regulations were finally released in August 2019 and operators — including Step by Step — were given three months to get ready for the changes.
In the last four days, the registrar has cancelled all five of Step by Step’s registrations. A letter has gone to the operator. And, according to the emailed response from an addictions ministry spokesperson, the operator is “expected to begin an orderly transition of current residents to other registered supportive recovery homes.”
The email also said that Surrey’s bylaw department will work with the operator to place the remaining residents to ensure that no one is left homeless as a result of the closures.
It’s a glimmer of good news. But it all happened four days too late for the unnamed man, for 21-year-old Zachary Plett, whose family will grimly mark the first anniversary of his death at Step by Step last Dec. 15. And it comes nearly 13 months after Step by Step staff took two full days to discover the body of a 35-year-old who overdosed in the house on Christmas Eve.
“Why they had to wait to get these regulations in place is beyond me,” Zachary’s mother Maggie Plett said Thursday. “They should have been done sooner.
1998: The NDP government brings in the first regulations under the Community Care Facilities Act.
2001: The B.C. Liberal government scrapped those regulations as part of its deregulation drive, declaring the requirements too onerous.
2014: A Surrey mother is murdered outside a hockey arena by a man living at one of the unregistered houses. At the time, Surrey alone had as many as 250 flophouses purporting to offer supportive housing for recovering addicts.
2016: In the spring’s Throne Speech, B.C. Liberals promise regulations, enforcement and a public registry.
In December, Surrey council voted to require all recovery houses to have business licenses, capping the number at 55 and requiring all of them to be listed on the B.C. government’s Assisted Living Registry.
The amendments to the Community Care and Assisted Living Act were never enacted or enforced.
2018: The B.C. coroners’ review of an overdose death in a Sechelt recovery house recommended that by September 2019 there needed to be better regulations for public and private residential addiction treatment facilities, as well as heightened enforcement.
The government agreed and set up a committee to develop standards to “help ensure quality and consistency and enhance understanding of the services across the province.”
April 2019: The deadline set by the coroner for a progress report came and went, but in a letter from the Ministry of Mental Health and Addictions in May, it promised to have a final report ready for September.
August 2019: Addictions Minister Judy Darcy announces that the 2016 regulations will finally be enacted along with some additional requirements on Dec. 1. To prepare for the changes, the government offered $4,000 in grants to operators licensed by the health authorities or registered by the ALR to offset staff training costs as well as an increase in per-diem rates for residents after more than a decade of having been stuck at $35.90.
B.C. Premier John Horgan speaks at The Council of Federation provincial and territorial Premiers meeting in Mississauga, Ont. jpg
VICTORIA — B.C. wants more money from Ottawa for health care before a national pharmacare program is created, says Premier John Horgan.
Horgan echoed other provincial and territorial leaders at this week’s Council of the Federation meeting in Toronto by calling for a 5.2 per cent increase in the annual federal health transfer, instead of the planned three per cent, as a first step before the federal government proceeds with universal prescription drug coverage.
“We were welcoming a discussion about a national pharmacare plan, but those of us who really already have significant plans would prefer that we first and foremost get back to a more equitable distribution of resources to deliver health care broadly,” Horgan said Monday.
An additional $30 million would flow to the province this year, were Ottawa to agree to increase transfers to the amount specified by the premiers.
Other premiers were more hesitant about a national pharmacare proposal, which Prime Minister Justin Trudeau promised in the election. They agreed to lobby for an opt-out clause if Ottawa decides to push the program into reality.
“Don’t start broadening health care when you can’t get it right now,” said Manitoba Premier Brian Pallister. “We need sustained funding.”
Canada’s current drug coverage system is a fragmented and unfair patchwork of more than 100 government-run plans and 100,000 private drug insurance programs, according to a June report by the federally commissioned Advisory Council on the Implementation of National Pharmacare. One in five Canadians have no drug coverage or inadequate coverage, the council found.
A single national system for prescription drugs would mean a copayment of as little as $2 a person for essential medicine and $5 a person for other drugs, as well as exemptions for those on social or disability assistance and a cap of $100 a year on any household payments, according to the council’s recommendations.
B.C. is budgeted to receive $5.4 billion in federal health transfers this fiscal year.
The province spends $23 billion of its $58.3-billion annual budget on health care and pharmacare.
Health Minister Adrian Dix said B.C.’s increases to health spending have outpaced the growth in federal transfers, and addressing that immediate financial pressure on existing services is the priority.
“Our priority is the Canada health transfer,” Dix said Tuesday. “But if (the federal government) comes forward with pharmacare proposals that actually have financial support behind them, then obviously that’d be of interest to every single province.
“What we’re saying is let’s get our fiscal house in order on the Canada health transfer, and then we can have that discussion.”
The federal advisory council, chaired by Dr. Erik Hoskins, recommended Ottawa cover all the additional costs for provinces in creating a national pharmacare program. That includes $3.5 billion by 2022 to launch a national system for essential medicines, and then $15.3 billion by 2027 after the system rolls in more coverage for different drugs.
National pharmacare would save an average Canadian household $350 a year in drug costs, businesses an average of $750 an employee for drug benefits, and employees $100 a year in plan premium payments, read the report.
Whether Ottawa can afford such a program, if it will introduce new taxes to recover the costs, or whether it expects the provinces to pick up part of the tab, are some of the questions expected to be addressed by the Trudeau government in Thursday’s federal throne speech.
It’s routine for premiers to push Ottawa to increase federal health transfers, said Steve Morgan, a professor of health policy at the University of B.C. who has studied national pharmacare for 25 years. But what’s different now is that politicians from the federal Liberals and NDP, which control the balance of power in Ottawa, promised action on national pharmacare in their election platforms.
“You’ve got a majority of a parliamentarians in Ottawa now who were elected as members of parties that had this kind of promise in their platforms, and that would suggest the provinces can expect significant funding,” said Morgan.
“But it will be funding with strings. Provinces just like more money without accountability. And pharmacare is a very significant offer of funding, but there will be very clear accountability. That’s exactly how we got Canadian medicare.”
A national program would also save between $5 billion to $7 billion annually in drug costs because Canada could exercise its bulk purchasing power and get better deals from manufacturers, said Morgan.
Politicians can expect pushback from private insurance companies and global pharmaceutical firms that stand to see profits reduced by a national Canadian program, he said.
“British Columbians should care about this because our system of financing medicine is an uncoordinated patchwork of public and private drug plans that results in many people falling through the gaps,” said Morgan. “It also results in everybody paying higher costs than they need to pay because truly universal systems of prescription drug coverage … those systems have enormous purchasing power on the world market for pharmaceuticals and may dramatically lower prices.”
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