There is a very real and deadly health crisis in B.C. from which two people died yesterday and two more will likely die today, tomorrow and the days after that.
It’s not COVID-19, and no news conference was hastily called to talk about it.
Most of those dead and dying are blue-collar guys in what should be the prime of their lives.
This is the reality as B.C. lurches into the fifth year of an opioid overdose crisis. It’s a seemingly unending emergency that by the end of 2019 had already killed 5,539 people here and more than 13,900 across Canada.
Five years in, this crisis has become normalized, with the only certainty as we face another day is that first responders are now better at resuscitating victims because, year over year, the calls have only continued to increase.
Last week, Prime Minister Justin Trudeau appointed his top ministers to a committee tasked with responding to the COVID-19 crisis. At that point, Canada had only 30 confirmed cases. Of the 21 B.C. cases, four of the patients have fully recovered.
Not to belittle the concerns about COVID-19 becoming a global pandemic, but with nearly 14,000 dead already, no committee — high-level or otherwise — has yet been struck to devise a national addictions strategy that would deal not only with opioids, but also the biggest killer, which is alcohol. A 2019 report by the Canadian Institute for Health Information found that 10 Canadians die every day from substance use, and three-quarters of those deaths are alcohol-related.
During the 2019 election, the issue flared briefly after Conservatives placed ads — mainly through ethnic media — claiming that Trudeau’s Liberals planned to legalize all drugs, including heroin.
Already beleaguered, Trudeau not only denied it, he quickly disavowed the resolution overwhelmingly passed at the party’s 2018 convention that called on the Canadian government to treat addiction as a health issue, expand treatment and harm reduction services, and decriminalize personal-use possession of all drugs, with people diverted away from the criminal courts and into treatment.
Trudeau disavowed it again this week when a Liberal backbencher’s private member’s bill was put on the order paper.
Depending on how you read Bill C-236, it’s either calling for decriminalization or legalization. Regardless, the fact that Nathaniel Erskine-Smith’s bill will be debated at least gets it on the political agenda because unless there are some major changes, Canadians are going to continue dying at these unacceptably high rates that have already caused the national life expectancy to drop.
Erskine-Smith, an Ontario MP from the Beaches-East York riding, favours a Portugal-style plan of which decriminalization plays only a small part.
But parliamentary rules forbid private member’s bills from committing the government to any new spending, so he said his bill could only narrowly focus on decriminalization.
The slim bill says charges could be laid “only if … the individual cannot be adequately dealt with by a warning or referral (to a program agency or service provider) … or by way of alternative measures.”
Erskine-Smith disagreed with the suggestion that it gives too much discretionary power to police — especially since in B.C., it’s prosecutors, not police, who determine whether charges are laid.
Still, what he proposes is quite different from what happens in Portugal.
There, police have no discretionary power. People found with illicit drugs are arrested and taken to the police station where the drugs are weighed, and the person is either charged with possession and sent to court or diverted to the Commission for the Dissuasion of Drug Use to meet with social workers, therapists and addictions specialists who map out a plan.
Since private members’ bills rarely pass, Erskine-Smith doesn’t hold out much hope for his.
It created a firestorm on social media, with some recovery advocates pitted against advocates for harm reduction, including full legalization.
Federal Conservatives also repeated their trope that drug legalization is part of Trudeau’s secret agenda.
Meanwhile, Alberta’s United Conservative government inflamed some harm-reduction advocates with the release of a report on the adverse social and economic impacts of safe consumption sites, even though it didn’t recommend shutting them down.
The report acknowledged that they play an important role in a continuum of care, but it also called for beefed-up enforcement to lessen the chaos that often surrounds them.
The committee questioned some data provided to them that suggested Lethbridge — population 92,730 — may be the world’s most-used injection site.
The committee also questioned why some operators report all adverse events, including non-life-threatening ones as overdoses, leaving the impression that without the sites “thousands of people would have fatally overdosed.”
Among its recommendations are better data collection using standardized definitions as well as better tracking of users to determine whether they are being referred to other services.
More than a year ago, Canadians overwhelmingly told the Angus Reid Institute that they supported mandatory treatment for opioid addiction.
Nearly half said they were willing to consider decriminalization. Nearly half also said that neither Ottawa nor the provinces were doing enough to ease the epidemic.
It seems Canadians are eager for change even if they’re not yet certain what it should look like. The only ones who seem reluctant are the politicians.
The interminable constitutional trial over the provision of private health care in B.C. — dubbed The Flying Dutchman of the B.C. Supreme Court by lawyers — finally made it back to harbour Friday.
In many ways, what should have been an intellectual cruise involving a few months of written argument and data from the medical system became a veritable Royal Commission that has generated a library of evidence. It involved 194 days of proceedings over 3 1/2 years that mocked timely justice and badly bruised the belief that the courts can act as an effective brake on bad government by providing a remedy to unconstitutional law-making.
The length of time and cost of the case are an argument that the courts are no longer capable of efficiently resolving such thorny questions of social policy.
As intervener lawyer Joseph Arvay said: “This case would appear to be, at least in my experience, the most complex Charter case I’ve ever seen. And one that truly does test the institutional competence of the court.”
At a time when more and more Canadians think the country isn’t working, the dysfunctional legal system must be considered a primary reason. Indigenous people have run into the same problem trying to hold governments to account through litigation — they too have found themselves bogged down in endless process that pours millions-of-dollars into lawyers’ pockets.
The duration brought its own risks and demands on memory — the constitutional challenge of two provisions of the Medicare Protection Act was nearly derailed late last year when B.C. Supreme Court Justice John Steeves required health care. This week Steeves couldn’t remember what prevented the government from enforcing the law.
“There is in place a consent order allowing private surgical services to continue,” Dr. Brian Day’s lawyer, Robert Grant, explained — issued by Justice Janet Winteringham following an injunction she granted in November 2018 after Victoria amended the law and planned enforcement, though its validity was in question.
“Did I sign that (order)?” the justice asked.
“No, it carries on from Justice Winteringham,” Grant replied.
“So, it has to do with the amendments, as I say, that occurred during my trial,” Steeves said.
“Exactly,” Grant said. “And what it did is effectively to confirm they won’t be employed until your lordship ruled, so that allowed the status quo to continue.”
“Maybe (government lawyer Jonathan) Penner can give the minister my compliments for making my job easier,” the justice quipped.
Two private clinics and a handful of patients launched the litigation roughly a decade ago because the constraints on dual practice by doctors and private health insurance would force private clinics and diagnostic centres across the province to close. No evidence or data was offered by either government to support the assertion that the private clinics cause harm to the public system and B.C. has not measured the impact or effect of the clinics that have existed for a generation.
“They would have welcomed an opportunity for an impartial objective empirical study,” Grant said. “It might have made this litigation unnecessary as it would have confirmed that private surgeries did not have any adverse effects on public surgeries.”
The Vancouver lawyer accused the government of grossly mischaracterizing and misrepresenting evidence in closing statements he said were little more than fearmongering. He pointed out B.C. has had de facto private health care for 20 years and the sky hasn’t fallen.
To end that status quo, he added, would make the public health system even more overcrowded as the 65,000 private surgeries done annually join already historically long waiting lists.
“Nobody gets ahead in the public queue by having private surgery,” Grant explained. “What happens is you leave the queue. You’re not jumping the queue, you’re leaving the queue.”
Instead of relevant data, the federal and provincial governments resorted to fervid rhetoric about the prospect of U.S.-style health care and the poor languishing in dirty beds at the mercy of greedy, unscrupulous physicians. At one point they accused a respected neurosurgeon of having “scaled back public work because he wanted more time to smell the roses and read a book.”
“This is an egregious mischaracterization of the evidence,” Grant told Steeves. “In fact (the doctor) suffered a family tragedy. His wife developed terminal cancer — and he needed to scale back his public on-call commitments as he couldn’t be operating all night due to his family’s needs … With his wife’s illness and passing, he could not do this with four children.”
Grant swept the broader accusations aside too:
“If there was one shred of evidence that doctors practising in the private system, just one piece, one example of a doctor performing private pay surgery, shirking a commitment to the public system or causing any problem at all for the public system, we can be certain they would have called that evidence, but they didn’t.”
He urged Steeves to draw an adverse inference from the government’s failure to call a single doctor or senior administrator to give evidence about problems the public system had experienced as a result of private surgeries.
“The evidence in this trial shows thousands of British Columbians wait too long past government-mandated medically maximum acceptable waits for their condition, risking progression of disease and in some cases shortened lifespan or death,” Grant concluded. “In evidence in this trial, is the fact that in one year, in just one health region in B.C., Fraser Health, 308 patients died waiting for medically necessary surgery. B.C. patients need a ‘safety valve’.”
Before the courtroom emptied, Steeves said: “I’m looking forward to completing my judgment and setting my name on it, and, once I’ve done that, I’ll join the rest of the world watching the progress of this case with great interest.”
He is expected to take several months, perhaps longer, on his ruling. Appeals are expected to follow, which means a final decision could be two, three or more years away.
Outside of court, Day, the face of the litigation, said he was relieved that the trial was over.
“Suffering patients — the more than 30,000 a year who wait past the government’s own maximum acceptable wait times, and the 18-a-week who die on public wait lists in B.C. — need the justice system to rescue themselves from their plight,” he said. “It’s astonishing that we are the only country on earth that outlaws private health insurance.”
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.
WARNING:This story contains graphic accounts of sexual violence that may be disturbing to some readers.
For 17 years, she criss-crossed Canada trying to flee the man who raped and tortured her and coerced her into prostitution and sexual slavery.
Regardless of what she did or where she went, her tormentor and the gang that he ran with were never far behind.
When she became pregnant with his child, he beat her badly enough that police were called. No charges were laid.
Over the years, he was twice arrested and convicted, but never jailed for assault or for breaching no-contact orders as part of his probation.
He spray-painted one of her homes with racist epithets, torched another and dropped off an eviscerated rat at yet another. Police were called. No charges were laid.
It all ended 12 years ago when, against incredible odds, the United States granted her asylum under the United Nations Convention Against Torture.
She didn’t have a lawyer, only two law students who with a professor’s help took it on as a class project.
U.S. Immigration Judge Kenneth Josephson relied on court precedents in concluding that domestic violence constitutes persecution, noting, “If the government is unable or unwilling to control persecution, it matters not who inflicts it.”
“There was no meaningful assistance provided to her,” he said, according to a transcription of his oral decision. He noted that she had made more than 30 attempts to get help from police and spent time in more than a dozen different transition houses across Canada and the United States.
“Obviously, Canada is a democratic, first-world country,” Josephson said. “While it is rare for a citizen of Canada to seek asylum, it is not rare to have claims presented on the basis of domestic violence.”
The judge also leaned heavily on Lisa Rupert’s affidavit describing how women are treated by Canadian police and courts. Rupert is the YWCA’s vice-president of housing services and violence protection in Vancouver.
Between 2003 and 2016, only 79 of 276 Canadian applicants were given asylum, according to the U.S. Justice Department. Because the reasons for decisions aren’t tracked, a spokesman said it’s not known how many were escaping domestic violence or gangs.
Because Rachel is still deemed by Canadian police to be at high risk, Rachel is a pseudonym. For her protection, other identifying details have been deliberately omitted or altered from the mountains of documents that she has meticulously saved over the years.
At our first meeting, Rachel insisted on one thing: “This story is not about him (the perpetrator) or the people he is involved with. … They get enough publicity for being the creepy people who they are.”
The story, she said, is about the failure of the Canadian police and courts to protect her and others like her.
Rachel is furious with Canada. She bitterly points to the country’s boast that it is a world leader when it comes to women’s rights.
“Between the RCMP and the court system, they dropped the ball and slid me down a million crevices, and then they did everything they could to cover it up.”
Now in her mid-50s, she lives at the edge of poverty in subsidized housing, scraping by on part-time and temporary work to supplement a $212-a-month disability pension from the U.S. government.
“I want the Canadian government to acknowledge what happened and repair as much of the damage as they can,” she said during one of many conversations over the past six months.
Rachel has paid dearly for her safety. It’s cost her everything she’s ever had and nearly everyone she’s known and loved.
She can never return to Canada. If she were to come even for a visit, she might be denied re-entry to the U.S. because the reason she was given asylum is that she’s at risk if she returns home.
Between the RCMP and the court system, they dropped the ball and slid me down a million crevices, and then they did everything they could to cover it up
Rachel has had to reinvent herself in a place where no one knew her or why she was there. She’s had to do it without any credentials, because her hard-earned college certificates are in her old name, and without job references because contacting Canadian employers risks having her new identity exposed.
She’s struggled with the effects of the trauma and abuse she’s endured, as well as guilt over the pain her life has caused her children.
Exile has also alienated her from Canada’s safety net, including health care, social assistance and the Canada Pension Plan.
That’s in addition to what she lost earlier when fear forced her to give up permanent custody of one of her children, cut off contact with her elderly parents, abruptly leave jobs and sell the family home she inherited from her parents in order to finance her fugitive life.
After 12 years in hiding, Rachel yearns for home. Canada Day, Canadian Thanksgiving and even Boxing Day trigger memories of happier times and thoughts about what might have been.
When she contemplated visiting Canada earlier this year, Canadian police advised her that she would be at high risk even if she only came for a few days.
The United States is the only place on the continent where she is safe. The man who hunted and abused her can’t cross the border because of his criminal convictions.
But even now, she’s extremely cautious, fearing he’ll find her again.
Meantime, her abuser has carried on. He’s served jail time for forcibly entering a home and assaulting another woman.
FATEFUL FIRST MEETING
Nearly 30 years ago, the vivacious, single, 20-something mom was singing with a band in a bar and attracted the unwanted attention of a guy who was never going to take no for an answer. It changed her world forever.
After she rebuffed him at the bar, he surreptitiously followed her home that night. The stalking had begun. He’d turn up at odd places. When she refused to go to his house for a barbecue with her child, he called repeatedly until she finally relented.
She thought that might be the end of it.
It was only the beginning.
His home was a grow-op. When she realized that, she grabbed her child and fled. He grabbed a rifle and fired a shot at her.
The phone was already ringing when she walked in the door of her home. She knew too much, he said. If she made trouble, his gang would kill her and her family.
Rachel changed her phone number, moved and quit her job. But a few weeks later, he was standing over her in her bedroom with a knife. He raped her repeatedly, pressing a pillow into her face to muffle her screams so she wouldn’t wake her child.
It went on for three days before he agreed that the child should be allowed to go stay with her father.
Over the next few weeks whenever she left the room, he went with her, carrying the switchblade knife. He began inviting some of his friends over. The more compliant she was, the more freedom he gave her. She began plotting her escape to a friend’s house in another community.
But he found out, took her car keys and her money and assaulted her. A few weeks later, he coerced her into taking him with her and the violence escalated.
He punished minor slights by locking her in the basement. In her U.S. immigration affidavit, Rachel wrote that he started humming the music from Psycho.
The RCMP report from one of the assaults that sent Rachel to hospital includes her statement describing how he wrapped a sheet around her neck and choked her before he lunged at her with a large knife.
She was thrown against a wall, thrown to the ground and kicked, according to the RCMP victim assistance supplementary report. He kept repeating that he was going to kill her.
When police interviewed Rachel about the assault, they didn’t want to hear about anything that had gone before that, she told the immigration judge. They refused to listen when she tried to tell them about how he’d coerced her into living with him, tortured and beaten her before.
Instead, they were the first of many to describe him as her boyfriend and suggest the violence was the result of her bad choices.
Although he was arrested, they didn’t detain him. They escorted him out of town as if it were all part of a Wild West movie.
It was no movie. A few days later, Rachel was released from hospital. As she was scrambling to pack the car and leave, he came out from behind the garage, grinning.
“Where are we going now?” he asked.
A month later and in another town, he beat her until she was unconscious. Once again, police weren’t interested in what had happened before, only what had happened that night.
He was charged with aggravated assault, but he later pleaded guilty to assault and was sentenced to nine months of probation and ordered to attend anger-management classes. There was no restraining order.
That night, he found her and raped her.
Within that first year, he coerced her into prostitution and made her audition for a porn film.
He also got her pregnant. When she refused to have an abortion, he assaulted her. Police came, but no charges were laid. A month after the child was born, he breached the order, robbed and assaulted her, burning her with a cigarette and punching her in the jaw.
“Strongly recommend that the accused be released only if a restraining order is put into effect,” the attending officer wrote. “No contact direct or indirect as accused harassing victim by repeated phone calls.”
Also in the report is the accused’s comment: “She’ll pay for this. She will know how this feels.”
Why police responded as they did, why he was never jailed for breaching no-contact orders and why he was never jailed at all are all questions that haunt Rachel and remain unanswered. Police don’t comment on individual cases and, aside from their decisions, judges don’t comment at all.
For 17 years, Rachel describes her life as a cat-and-mouse chase.
“I thought he’d eventually give up and move on. I didn’t think it would be a 17-year problem or that I would eventually have to leave the country,” she told me.
“I kept thinking, ‘Now, the police will do something. Now, it’s going to stop.’”
But the timeline chronicling her torment runs to eight pages. He’d breach the orders. She’d escape to a shelter and he’d find her. He’d beat her; police would be called. Only twice were restraining orders issued. He was never sent to jail.
When he couldn’t catch and assault her, he’d vandalize her home or threaten her employers. When he couldn’t find her, he’d threaten her parents.
One summer, she and her child lived off the grid in a tent bought at Zellers. When the $300 that she’d hidden from him ran out, she begged a telephone operator to find the number for a women’s shelter and put her through.
Less than a month later, her relentless and well-connected abuser found them there.
Another time and in a different shelter, a gang-connected woman wheedled her way in to deliver the message that he was watching.
Rachel relinquished permanent custody of her child from a previous relationship as a protection from the violence that permeated her life.
Later, exhausted from the threats and running, Rachel asked the child protection ministry to take the child that she’d had with her abuser into temporary care on the condition that the child’s father not be contacted.
But a social worker broke that agreement and contacted Rachel’s abuser even though his name is not on the child’s birth certificate. Because of that breach of privacy, Rachel very nearly ended up having to share custody with the man who was making her life hell.
Not only would it have meant regular contact with him, Rachel could never have got asylum in the U.S. With a custody order in place, she could have been charged with abduction if she had taken the child out of the country without his permission.
Instead, his custody attempt was the impetus for her exile.
REPEATED PLEAS FOR HELP
Over the years, Rachel has approached the Canadian government for help. She’s kept every email and letter, along with names and phone numbers of the various officials she’s spoken to.
Initially, she asked for compensation for the house she was forced to sell at below market price in 1997 to finance her fugitive life. When it sold again recently, it was for $1.4 million.
Last fall, she tried to get help accessing disability benefits under the Canada Pension Plan, which she paid into from the time she started a part-time job as a high-school student.
To get benefits, she needs a birth certificate and social insurance number. Rachel believes it’s too risky to apply for CPP under her old name, so she needs new documents.
After a flurry of email exchanges and phone calls, nothing has happened, just as nothing happened in the 1990s when Rachel begged police to give her a new identity.
Among the problems is Canada’s disjointed system, name changes and birth certificates are provincial. Social insurance numbers and CPP are federal. Each requires a separate application. Each application costs money that Rachel can ill afford.
But even before she can apply, Rachel would have to apply to be allowed to apply from outside Canada. That’s a whole other process.
For nearly 30 years, Rachel has been told there’s another problem with getting her name changed in Canada.
When she was in her late teens, Rachel defrauded a telephone company of $2,000 worth of telephone service by using a fake name.
“It was kid stuff, poor-people stuff,” she said.
She pleaded guilty and was sentenced to three years’ probation with 200 hours of community service and the requirement that she repay the money. She tried, but couldn’t manage to do all of that.
Even with the support of her probation officer, the judge refused to amend the probation order and clear the way for a later pardon, or what’s now called a record suspension. Because of her record, her only safe choice was an extreme one. Flight.
The United States gave her a waiver before granting her asylum and a new identity. Why shouldn’t Canada do that for her now?
STILL AT RISK
Rachel has lived in fear for half her life. She still struggles to accept that for as long as her assailant is alive, her life is at risk.
Violence, threats and coercion forced her into hiding, into exile and into poverty that affected not only her but her children.
Unable to return to her country of birth, she missed major milestones in her children’s lives. She is unable to visit her parents’ graves.
But among the facts of her life that Rachel finds most galling is that her punishment for defrauding a phone company of $2,000 was three times as long as any sentence her assailant ever received for nearly killing her.
As B.C. heads into the fifth year of a public health emergency due to the high number of opioid overdose deaths, Vancouver Island still doesn’t have a single residential-treatment for youth. Provincewide, the number of youth beds and services lag demand.
For youth who do get one of those precious treatment beds, their transition back to community-based services is badly planned and poorly managed.
Had all of that been in place, 16-year-old Elliot Cleveland Eurchuk might have survived his addiction rather than being counted among the 4,850 British Columbians to have died between January 2016 and Oct. 31, 2019.
But the teen’s legacy could be — should be — that Health Minister Adrian Dix and Premier John Horgan making addictions treatment as much of a priority as harm reduction.
Recommendations from the coroner’s inquest into Eurchuk’s 2018 death released on Monday provide some direction: More acute-care beds for youths including a residential treatment centre in Victoria; more and better access to addictions services; and resources for early detection of mental-health and substance-use disorders among youth.
For more, the government ought to dig out its copies of the 2018 report from the B.C. Centre on Substance Use that recommended a “full, evidence-based continuum of care including building an effective and coordinated addiction treatment and recovery system that has traditionally been lacking.”
That report also singled out the need for youth-specific services and treatment including residential care. It also recommended “recovery high schools” where not only are drugs and alcohol are strictly prohibited, treatment and services are part of the curriculum.
Men aged 19 to 59 make up the overwhelming majority of the people who have died of opioid overdoses. But, an average of 18 youths have died in each of the past four years.
The recommendations aren’t only aimed at preventing youth from dying. They’re aimed at providing treatment to prevent their addictions from becoming entrenched.
In addition to the recommendations, the coroner’s report provides a glimpse of the other opioid crisis far away from Vancouver’s Downtown Eastside.
Eurchuk knew about harm reduction services, but he didn’t get his drugs tested, didn’t go to safe injection sites, didn’t seek treatment or replacement therapies such as methadone or Suboxone.
He’d started using cannabis in November 2015 when he was 13. After injuring his shoulder wrestling a year later, he began self-medicating, buying hydromorphone from a classmate at Oak Bay High School.
In December 2016, he broke his jaw playing soccer and, after surgery, was prescribed hydromorphone for the pain. Two months later, he had the first of two surgeries on his shoulder and was prescribed another opioid, Tramacet, for the pain.
After reinjuring his shoulder that fall, Eurchuk was given another prescription for Tramacet. He was also suspended from school, accused of selling drugs to classmates.
After a second shoulder operation that October, Eurchuk got a five-day prescription for Oxycodone, followed up by a prescription for Tramacet.
In the final months of his life, Eurchuk was routinely using opioids to the point that when he was hospitalized in early 2018 for a serious infection, he got a day pass and got fentanyl and cocaine while he was out. He went into cardiac arrest in the hospital on his return.
He was home briefly in February before being readmitted under the Mental Health Act. Discharged after a week, Eurchuk was in the emergency room of Vancouver’s St. Paul’s Hospital in March because of decreased consciousness and released after a few hours.
On his final day, Eurchuk bought a two-day supply from a street dealer, used with a friend early in the evening and was heavily intoxicated by the time they parted ways. As the evening wore on, people who saw him described him as everything from fine to agitated to disoriented. He was last seen at midnight.
The teen died on the morning of April 10 at home from a heart attack, fluid in the lungs and aspiration caused by “mixed intoxication” from fentanyl, cocaine, heroin and methamphetamine.
Attempts to revive him with naloxone, chest compressions, suction and a defibrillator failed.
While the government will provide a written response to the coroner’s recommendations in the coming weeks, last summer it committed $2.4 million over three years to addictions and mental health programs.
It has opened four youth detox beds in Victoria. There are eight Foundry Centres across the province providing comprehensive supports with three more being developed. And, this spring, a 20-bed treatment facility in Chilliwack is scheduled to open.
There is no guarantee that better acute-care treatment, earlier interventions and more comprehensive community services will save the lives of every addicted youth or that they would have saved Eurchuk.
Addiction is, after all, a chronic, relapsing condition.
Elliot Eurchuk was just a kid and there are others like him. They deserve the best chance possible to grow up to be healthy adults.
In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them. AlexRaths / Getty Images/iStockphoto
Some corporate-owned, long-term care homes in B.C. are getting money for nothing, while not-for-profits may be getting less than they need for their services to be sustainable.
But the bottom line is that the losers are both vulnerable seniors and taxpayers who are footing the $1.3-billion annual bill.
To be clear, it may be unconscionable, but for-profit operators who run a third of all the long-term homes and beds in B.C. are not breaking any rules. Just as it’s fair to assume that not-for-profits, who account for another third of the total, aren’t deliberately leaving money on the table.
The problem is that the system is broken.
Patients and their families have been complaining for years. On Tuesday, B.C. Seniors Advocate Isobel Mackenzie clearly set out the evidence in her report, A Billion Reasons to Care, which comes within a few months of Island Health taking over three privately operated homes.
Mackenzie’s funding review is a scorching indictment of the government’s failure to properly manage one of the largest contracting relationships it has with service providers. To some extent, Mackenzie said, the government is handing long-term care operators blank cheques.
She said the rules haven’t kept pace with the fundamental shift in government procurement policy that began 20 years ago when long-term care was contracted out to private operators who were then allowed to opt out of the Health Employers Association of B.C., which once bargained on behalf of all publicly funded, health-care employers.
Rules are non-existent, vague or not uniformly applied. Direct care hours, for example, aren’t necessarily separated out from the hours that care aides spend on food service or housekeeping. Financial monitoring is scant with no requirement for detailed or audited reports.
In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them. Were they fined? No. They got to keep the money.
Meantime, not-for-profit operators delivered 80,000 hours of care more than they were contracted to provide. Those extra hours were paid for either by lower costs in another area or by other funding sources.
It is true that all operators face a staffing crisis that Mackenzie describes as being of epidemic proportions, with nearly 90 per cent of care homes not able to meet minimum staffing guidelines.
But it’s partially self-inflicted. For-profit operators’ wage costs for each hour of direct care is lower across all classifications than the costs at not-for-profits and the homes run directly by health authorities.
Some for-profits are paying care aides, who provide two-thirds of the care, nearly a third less than the industry standard, which works out to $6.63 an hour. Part of the difference is that for-profit operators are more likely to hire part-time rather than full-time workers, which eliminates the need to pay benefits.
Raise the salaries, says Mackenzie, and workers will follow the money.
The government and health authorities should also follow the money. Rather than setting a minimum wage or requiring that all operators pay the industry standard, Mackenzie says to simply end the incentive to not deliver the care. If operators didn’t deliver 207,000 hours of care, they should have been required to give that money back.
But there are no penalties in any of the contracts. Don’t deliver and, ka-ching!, the bottom line suddenly looks a lot better as taxpayers’ money transforms into shareholder profits.
Disturbingly, Mackenzie found that contracts varied both between and within health authorities.
“All spoke to delivery of care,” she said Tuesday. “But none specified the type of care. None outlined any legal requirements to provide the care. And none had explicit penalties for non-compliance.”
Every health authority also had different reporting systems. Different ones allowed expenses to be claimed differently. There were also anomalies between the profit and non-profit operators, including for-profits having surpluses 12 times higher and profits three times higher.
The health authorities allowed for-profit operators to claim building expenses at 20 per cent of their revenues compared to the not-for-profits’ nine per cent. They also allowed mortgage interest rates considerably higher than market rates, double the depreciation rates, unexplained lump-sum payments to contractors working for affiliated companies, unspecified management fees in addition to administrative expenses that are higher than non-profits.
One concern Mackenzie has about non-profits claiming lower building expenses is that they will not be able to upgrade their facilities as they age, meet any new accessibility requirements that may be required, or expand to meet the tsunami of demand from an aging population.
It all needs to change and change quickly before even more public money is funnelled into corporate profits at the expense of vulnerable seniors who aren’t getting the care they need and deserve.
A teacher who is living with his pregnant Canadian wife and child in a city that is the epicentre of China’s coronavirus outbreak is hoping to get out of the country on a British flight.
Tom Williams is hoping to get his wife, Lauren, who is about 35 weeks pregnant, out of Wuhan, a city that has been essentially locked down with the emergence of the disease. The couple also has a two-and-a-half-year-old son, James, who is Canadian.
Williams is a British expat and his wife and son are from British Columbia.
“We’re just currently waiting to hear confirmation whether we’ve got space on the British flight,” Williams told The Canadian Press in a FaceTime interview from China on Wednesday.
The family received a call from officials in Ottawa earlier this week, who asked permission to share his wife’s file with the British Embassy, he said.
“We have some stuff laid out in case it’s a last-minute departure.”
The virus has killed 132 people and infected more than 6,000 on the Chinese mainland and abroad.
The Williams family is among 126 Canadians the federal government says have asked for help leaving Wuhan.
Prime Minister Justin Trudeau said Wednesday that his government is working closely with Canadian consular officials in China.
“We’re listening and concerned about Canadians who are right now in the affected zone,” Trudeau said in Ottawa.
“We will look at what we can do. There are many countries looking at different ways to help out,” he said. “It is a complex situation.”
Federal Health Minister Patty Hajdu said her department has been in touch with U.S. officials about their repatriation plan.
Canada’s chief public health officer, Dr. Theresa Tam, will brief MPs on the Commons health committee Wednesday afternoon.
On Tuesday, Foreign Affairs Minister Francois-Philippe Champagne said the government is “looking at all options.”
“Every Canadian that has reached out to us for consular assistance will receive it,” he said.
At least 250 Canadians have registered with Global Affairs Canada to say they are in Wuhan, said Champagne, who added that officials are trying to contact everyone to assess their needs. He said Canada will tailor its response based on what it learns.
Williams said looking at options isn’t really helping people on the ground, although he understands that Canada doesn’t have a diplomatic presence in Wuhan, a city of 11 million. Canadian offices in Beijing and Shanghai are closed until Sunday for the Lunar New Year holiday.
“We’re just a little anxious and hoping for some answers pretty soon,” said Williams, who added that he and his family are “still healthy and still OK.”
The family went out during the day Wednesday and the streets were “very quiet,” he said. They take their temperatures whenever they enter and leave their apartment complex.
James was watching “Toy Story” Wednesday afternoon.
“He’s a little bit clingy, but we’re doing our best with train sets and different things. Trying to keep him entertained.”
Canadian Wayne Duplessis, who teaches in China, said he and his family registered with the emergency response centre in Ottawa to know what help may be available in Wuhan.
But Duplessis, who is originally from Espanola, Ont., said he is not looking to leave.
Most people he knows are taking the situation in stride, although he said there is “a certain resignation” and “despair.” Duplessis and his family members take their temperatures every morning at breakfast.
More restrictions have been placed on cars and some people are worried those might affect day-to-day activities such as getting groceries, he said.
From his 28th-floor balcony, Duplessis said he could see the highway, usually buzzing with activity, was empty.
“The IKEA mall across the street is empty, which is too bad. There’s great lunches there,” he said.
In the midst of a whirlwind coast-to-coast tour to consult Canadians about medical assistance in dying, federal Justice Minister David Lametti interrupted his Vancouver breakfast Friday.
Under pressure of a March 11 deadline set by the Quebec Superior Court, Lametti hopes to quickly craft amendments he can put to parliament that will make the still-controversial law, often called MAID, constitutionally compliant.
“We’ve all been touched by it,” he confided, setting down his coffee. “I’ll tell you my story if you want to hear it.”
As with so many individuals and families, Lametti has personally confronted an excruciating life-and-death decision involving a loved one.
“In 2016, when we were passing the original legislation, I watched my mother die of a rather negative form of dementia, and it wasn’t easy,” he explained.
“I knew, I had spoken to her (about medical assistance in dying) 10 years before. She was a devout Catholic, and I knew what her beliefs were. So I never would have considered assisted dying for her.”
The 57-year-old former McGill law professor, more comfortable quoting legal precedent than an example from his own life, continued:
“My brothers and I were well aware of what her feelings were. That being said, we did at a certain point have to make a decision that she not undergo further treatment — which is in a sense a delegated decision, although fully within her belief structure, within the church’s belief structure, and within the medical structure.”
Lametti said Canadians have long accepted such delegated decisions when a life was at stake.
“This MAID provides another way for people to chose in an autonomous fashion how they wish to end their life given certain conditions, and usually under very tragic circumstances or sad circumstances or personal circumstances. And it allows for people to do it in a positive, oftentimes spiritual, oftentimes uplifting way.”
Still, in September, the Quebec court said the federal law was too restrictive — allowing MAID only to those facing “reasonably foreseeable” or, depending on your vocabulary, “imminent” death.
Ottawa decided not to appeal the ruling, but was hampered in responding because the decision came down as the federal election campaign started. Now, time is running out.
“We’re consulting experts, MAID providers, we’re consulting persons who feel vulnerable because of the legislation, some people with disabilities,” Lametti said.
“While we’re doing it, we’re trying to touch base with Canadians on a couple of specific issues around advance requests, which we know some Canadians are interested in. … Would people allow for someone who had been evaluated and approved to benefit from MAID even after they have lost consciousness or capacity?
“And then another advance request from someone who had been diagnosed with a well-known progressive disease, so Alzheimer’s, if you get the diagnosis and say, ‘Look, when I reach this stage, I would like the benefit of MAID.’ We’ll see … if there is consensus among Canadians.”
The MP for the Montreal riding of Lasalle-Émard-Verdun, Lametti said more than 150,000 have responded already.
He pointed out the review was also a bit of an advance scout because the original 2016 MAID legislation contained within it a five-year evaluation process that will begin in June.
Lametti said it will “deal with the really tough issues — mature minors, mental disability and advance requests more generally.”
But he did not think the law itself was under threat:
“The experience that we’ve heard now from caregivers across Canada, from families who have had a loved one benefit from MAID has been I think relatively positive. I think maybe even overwhelmingly positive. … And I think there is a large acceptance of the practice amongst practitioners, amongst people who are facing, in particular, terminal illness. So I think the practice is here to stay and the question is how much farther do we push the boundaries.”
Still, he acknowledged there were passionate critics of MAID, especially among some faiths.
“I hope we don’t reach the same kind of polemics that we do with a question like abortion,” the justice minister said. “But there are a number of legitimate concerns that are raised by people who worry, people living with disabilities, for example, feel vulnerable, and legitimately feel vulnerable. They see themselves as being susceptible to being influenced by others who say, ‘Well, you know, you’d be better off dead.’”
This is about individual autonomy, he insisted.
“But we also, as a government, have to be sensitive, as a society we have to be sensitive, to what one might call quality-of-life issues. We need to make sure the quality and value of care is as best as it can be for people who choose not to have assisted dying but to end their days following a more natural progression,” Lametti said.
“Same is true for other life issues, people living with disabilities or people living with other forms of suffering who want to live and — whether it’s because they want to see their kids grow up, or whether it’s because they want to share more time with loved ones, or they have other things they want to accomplish in life — we need to make sure people can live fulfilling and productive lives even with the suffering they are going through.”
A B.C. justice has again thumbed her nose at the public by blocking video-recording of the extradition hearing for U.S. fugitive and celebrity Chinese capitalist Meng Wanzhou, a.k.a. Cathy Meng and Sabrina Meng.
Associate Chief Justice Heather Holmes of the B.C. Supreme Court maintained broadcast or streamed recordings would create too great a risk because they could be manipulated and used to discredit the administration of justice.
“The key concern is Ms. Meng’s right to a fair trial in the U.S.A., should she be extradited,” Holmes insisted. “For portions of these extradition proceedings to be broadcast — even the double criminality hearing — would in my view put that right at serious risk by potentially tainting trial witness testimony and the juror pool.”
Given the U.S. has very liberal pretrial publicity laws compared to Canada, what’s the risk?
“The very height and intensity of the public interest that motivates the media consortium’s application suggest that the risk of context-less ‘sound bite’ rebroadcasts by other media organizations or by individuals will be extremely high,” Holmes wrote in the ruling published on Tuesday.
“Also, what the media consortium describes as the ‘politicized’ nature of the case suggests a real risk that distorted representations would be created and broadcast by others for purposes contrary to the proper administration of justice.”
In other words, legitimate coverage might be bastardized and turned into satire or worse, fake news, misleading people.
Who’s Holmes kidding? America’s entire judicial process is exponentially more open than Canada’s and just about every major case is fodder for Netflix or prime-time television from bail hearing on.
And what do amorphous trial-fairness issues down south have to do with blocking Canadians, most of whom can’t attend the court, from seeing what happens at the hearing of the Huawei telecom executive?
Especially when Michael Kovrig and Michael Spavor, our citizens, are likely to be subjected to a Chinese show trial after being held in abominable solitary confinement, so far for more than a year, in retaliation for Meng’s arrest on Dec. 1, 2018?
This was a perfect opportunity to let Canadians see how their justice system actually works and show them, if nothing else, that our judges don’t use gavels.
Thirteen organizations formed a media consortium — everyone from CNN to the South China Morning Post — and applied for authorization to video record and broadcast (by webcasting, online streaming, and televising) the portion of the committal hearing concerning “double criminality.”
Set to start Monday for up to five days, those proceedings will address whether the conduct alleged in the U.S. extradition request is also a crime in Canada.
The argument for broadcast is compelling — this case engages domestic and international political and economic issues, attracting significant interest locally, nationally and internationally.
Although the courtroom is open, most people cannot attend; online streaming and broadcasting of the proceedings is necessary to make the court realistically accessible.
Increased access to the court’s process and decision-making would, in turn, improve the public’s understanding and confidence in the administration of justice while fostering public debate and participation in our democracy.
Not surprisingly, Meng and the federal government opposed the application.
Still, instead of a cogent ruling expressing concrete concerns, Holmes conjured fears that streaming or broadcast reports could be such fodder for mischief, that they threaten Meng’s trial.
In 2015, the court suggested it was open to video recording and broadcasting by issuing a practice directive that purported to provide rules and guidelines. Significantly, the footage could not be broadcast in any way for at least two hours after the event to allow time for any concerns to be raised and addressed by the court about specific content.
The double criminality portion of Meng’s extradition involves only a question of law, and, as the judge noted, will not directly engage Meng’s fair trial rights since it does not pertain to her guilt or innocence.
Counsel are experienced and able. No party is under a legal disability. No graphic material will be presented. The recording would be done without any disturbance of courtroom proceedings.
Yet Holmes couldn’t bring herself to let the public watch on a screen because of a hypothetical concern.
This is out-of-control judicial paternalism and only confirms my suspicion that for far too many B.C. judges, the open court principle deserves lip service, little more.
It’s the same the-public-can’t-handle-the truth attitude that has seen routine publication bans and courtrooms closed.
Premier Christy Clark promised to televise the trials of Stanley Cup rioters — didn’t happen. Former attorney general Mike de Jong wanted to allow cameras in courthouses to televise sentence hearings, as Manitoba did a few years ago — fat chance. In 2001, there were calls to televise former premier Glen Clark’s trial. …
It’s been more than half a decade since the B.C. Court of Appeal streamed arguments in the right-to-die legal battle as a proposed pilot project and nine years since the B.C. Supreme Court televised the polygamy constitutional question as a similar experiment. At the turn of the century in Victoria, cameras recorded part of the trial of nine South Korean men accused of human smuggling as a so-called pilot project.
These have been rare events.
Canadians were able to watch the drama at Oscar Pistorius’s murder trial in South Africa and can daily catch proceedings from across the U.S. The British, who routinely broadcast Supreme Court and some appeal court proceedings, later this year will start broadcasting the sentencing of convicted offenders in high-profile criminal cases in England and Wales, including murders and rapes.
The reason? To enable greater public understanding and scrutiny of courtroom hearings.
The Supreme Court of Canada has broadcast its proceedings since the 1990s.
In 2016, when Postmedia and The Vancouver Sun applied to broadcast portions of the landmark constitutional challenge over the protection of medicare, the judge found a way to dismiss the application, too.
After four years of bad trial management and squabbling, I can understand why the bench doesn’t want the public watching.
As the overall area of cannabis production increases, so do the problems and their chances of spreading. Growers across North America are currently facing a root aphid outbreak that appears to have started in Colorado.
Punja said the appearance of some pests was predictable as Canada moved to a regulated industry. Spider mites, for example, are an issue for growers of almost every crop in B.C.
“It’s certainly not unexpected to see them,” said Brown, who works for Biobest Canada.
But other pests are less common.
“Pests that only target cannabis are more difficult to treat. We’ve had less time to study what works,” she said.
Bugs like cannabis aphids aren’t new, but in the previously illegal industry, growers weren’t limited by regulations.
“If they came upon these tricky pests, they could spray something and nobody would know,” she said.
Health Canada regulations forbid the use of chemical pesticides, including some that have been deemed safe for use in food production, meaning growers must depend on an arsenal of organic and biological products, including beneficial insects.
“It’s not as simple as replacing Chemical X with Bug Y,” said Brown.
The specialist helps growers develop pest-control programs that are tailored to their crops, growing style and pest problems. She believes that in time cannabis production and pest-management strategies will become more standardized across Canada.
Punja, too, is at the forefront of disease-management practices. His focus is on identifying the problem and how it arrived at a specific facility, whether it was through movement of plant material or on a worker’s clothing.
Prevention and management often involve cleanliness, as well as the quarantine of infected plants.
The scientist believes Health Canada may eventually approve more products for pest management, but research is needed to make the case to the federal Health Ministry. The companies that produce chemical pesticides may be reluctant to undertake the research or make the application since many of them are based in the U.S. where cannabis is still illegal under federal law.
A limited number of products approved for cannabis — about 21 non-chemical approaches, compared with almost 100 chemical and non-chemical approaches for tomatoes — means Canadian cannabis growers must be innovative to deal with pests.
“In talking to producers, they seem very keen to try new things,” said Punja. “I don’t see this hindering them.”
BBG Constructive & Security Installation Consultants is a multi-disciplinary property and construction consultancy. Working with businesses on built-environment projects, we are client-focused with the recognised experience, knowledge base, expertise and track record to tackle projects irrespective of complexity from a position of strength.