Lorian Hardcastle Profile picture
Sep 13, 2020 7 tweets 2 min read Read on X
Some thoughts on this article, which suggests that the ruling in the BC private health care case is inconsistent with SCC jurisprudence and thus vulnerable to appeal: nationalpost.com/news/canada/b-…
While one of the parts of BC's law was similar to that challenged in Chaoulli (ban on private insurance), the BC case addressed other rules like limits on extra billing.
There are significant differences in Quebec's 2005 health system and BC's 2020 system. For example, while judges in Chaoulli disagreed on how to assess unreasonable waits, the judge in BC relied on benchmarks that didn't exist in Quebec in 2005.
The constitutional jurisprudence has evolved in the last 15 years. Many were very critical of the SCC's approach in Chaoulli. The majority appeared to substitute their own policy choices for those of the government, rather than applying the proper legal test.
The quality of the evidence in the BC case was much better and the judge's analysis of it was methodical. He didn't fall into the Chaoulli trap of failing to appreciate that health policies from one political/legal/social climate cannot be easily imported to Canada.
The $ backers of Brian Day claim that subsequent Supreme Court cases "stand for the same principle: that the government cannot undermine measures that help protect people". This is a preposterous oversimplification of the cases that she cites.
I read the whole 880 pages yesterday and will be posting a blog post on Monday that summarizes the case.

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More from @Lorian_H

Nov 18
Watching the press conference on "refocusing" the health system (ie breaking it up into 4 organizations).

Primary Care Alberta will start its work today. AHS replacement called Acute Care Alberta will begin work in early spring (later than originally announced). /1
She says Albertan's deserve improved access. Unclear how this will improve access, as they have not presented any evidence for this model and new bureaucratic structures don't tend to speed things up.

AHS & other acute care providers will be accountable to Acute Care AB. /2
Transition team comprised of AHS execs & Dr. Chris Eagle ("external special advisor").

Primary Care AB's initial work will be to implement corporate policies and processes, develop operational plans and set vision, mission & performance targets./3
Read 13 tweets
Oct 28
Bill amending the Alberta Bill of Rights introduced. New provisions:
Right for individual with capacity not to be subjected to or coerced into receiving medical care, treatment, or procedures without consent unless likely to cause substantial harm to themselves or others. /1
Right to freedom of expression, broadening the scope of Albertans’ rights protected beyond written and spoken language to include other expressive activities.
Right to acquire, keep and use firearms in accordance with the law.
Expanded property rights. /2
Currently applies to laws but would now apply to all provincial gov action, including policies and programs, and to organizations that operate under extensive government control, such as municipalities, police services, and some activities of hospitals. /3
Read 17 tweets
May 14
Bill 22 (Health Statutes Amendment Act) now tabled. Broadly, will enable transition from Alberta Health Services to 4 new organizations, each responsible for a different silo of the health system (it remains unclear why gov is moving away from an integrated model) /1
4 agencies (primary, acute, continuing, mental health & addiction) will deliver or arrange delivery (contract out?) services, evaluate & adjust to meet needs, implement ministerial plans, ensure integrated transfers within & between sectors (will be a huge job!). /2
Minister of Health will be "oversight minister" and set strategic direction and sector ministers will be responsible for each of the 4 sectors /3
Read 8 tweets
Nov 15, 2023
Manning report on covid has dropped. Notably, the panel's mandate wasn't to look broadly into the management of covid, but more narrowly to look at governance in a public health emergency. /1
I'm not going to disparage any specific person, but it is fair to say that the panel's composition seems designed to reach particular conclusions on the issues. /2
Report immediately mischaracterizes who makes decisions in a pub health emergency by putting Cabinet at the top of the list and saying cmoh is merely "highly relevant". Although that's what happened during covid, the law is quite different (for now...see bill 6). /3
Read 30 tweets
Nov 8, 2023
Watching the presser on changes to the health system...

Smith highlights challenges with staffing and surgical wait times, but unclear how their proposed reforms will fix any of this. Says that current system lacks accountability and falls short on putting patients 1st /1
Delivery system will now focus on 4 areas, each with their own organization: primary care, acute care, continuing care, mental health & addiction. Calls current AHS structure "scattered" and "rigid". Will apply province-wide to avoid pre-AHS regional fragmentation. /2
Smith says this new model will be more responsive to issues, better able to mange performance, more accountable, more adaptable to innovation, and responsive to make space for local input. Unclear how the new model will facilitate these goals. /3
Read 20 tweets
Nov 2, 2023
Gov announced forthcoming changes to the Public Health Act today that will give cabinet greater power over decisions during a public health emergency. Some thoughts... /1
First, clarity over the role of the CMOH was much needed. This should have been fixed much, much sooner when it became clear that what was happening during covid (i.e. cabinet making decisions) was out of step with the law (i.e. CMOH making decisions). /2
Two questions required attention. First, who ought to make decisions during a health emergency (CMOH, cabinet, combo)? And second, how much independence should the CMOH have (e.g. a bureaucrat reporting to the Minister of Health or able to disclose recommendations publicly)? /3
Read 10 tweets

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