Bill 54, the Homecare and Community Service Amendment Act (also known as Dan’s Law) is recently back in the news as various medical associations and others lobby the current government to pass the Bill before June's pending provincial election. First introduced by Windsor West MPP Lisa Gretzky, the Bill seeks to remove the three-month waiting period for access to OHIP funded palliative care and home care for Canadian residents who move to or return to Ontario.

A Short History of the Bill

The Bill is named after former Windsor autoworker Dan Duma, who died one month into a three-month wait for home care while fighting liver cancer. Duma and his wife moved to Fort McMurray to find work after the GM plant in Windsor shut down. While in Alberta, Duma was diagnosed with liver cancer and told he only had a short time to live. He and his wife decided to return to Ontario, where their two daughters had continued to live, for palliative care. The couple ran into bureaucratic red tape. OHIP requires new Ontario residents (including former Ontario residents who moved away and then returned to Ontario) to wait three months for coverage. During that three-month window, new residents can be admitted to hospital to receive medical care, but do not qualify for hospice care or home care. The Bill seeks to eliminate this very situation. Duma was able to move in with one of his daughters. The daughters, who both have medical training (as a nurse practitioner and registered nurse, respectively), took turns caring for their father. Outside of this family care, Duma received no formal homecare. Duma’s palliative care physician, Dr. Darren Cargill, was able to make house calls. Cargill also puled some strings to place Duma in a hospice bed in Leamington, otherwise Duma would have spent his remaining days in a hospital. Duma was unable to fulfill his wish of dying at home, surrounded by his family. Dr. Cargill told the Windsor Star,

We could have taken better care of Dan…t was like trying to care for a patient with one hand tied behind your back.

Current Status of the Bill

The Bill received its second reading in legislature in 2016 and was supposed to be reviewed by the justice policy committee but has remained in limbo since then. Dr. Cargill has been a vocal advocate in favour of Dan’s Law. With the provincial election on the horizon, Dr. Cargill is increasing his efforts to lobby the current government, fearing that the Bill will die if it is not passed before the current legislative session ends. Dr. Cargill notes that there is no medical or financial justification for the current three month waiting period for new and returning residents. During this window, doctor fees and other costs, including the cost of acute care beds in hospitals are covered and billed to the patient’s home province by virtue of inter-provincial reciprocal billing agreements that Ontario has with other jurisdictions. Dr. Cargill notes that homecare and hospice care costs a fraction of an acute care bed in a hospital, with an acute care bed costing about $1000 a day but “giving families support to care for a loved one at home costs the province $150 to $250 a day”. Dr. Cargill is urging people to contact the new Health Minister, house leaders for each party, and Liberal MPP Shafiq Qaadri, the head of the committee who is supposed to address the Bill.

Support for the Bill

Both the Ontario Medical Association (OMA) and the Ontario Nurses Association have endorsed the Bill, with the OMA recently Tweeting its support:

Ontario’s doctors support Dan’s Law to improve access to palliative home care. @Yasir_Naqvi, @jwilsonmpp & @BissonGilles please pass #Bill54 to allow palliative care patients the dignity of dying at home closer to their families. https://t.co/HHDqRlJepx #Onpoli pic.twitter.com/bIfGMCP4XK

— Ontario Medical Assoc. (@OntariosDoctors) March 7, 2018

For her part, Ms. Gretzky has noted her disappointment with the progress of the Bill, telling the Windsor Star that she does not understand why the Bill "is not moving faster" since, to her knowledge, there has been no opposition to it. She argues that the Bill provides an opportunity to make better use of acute care beds at a time when hospitals are regularly operating over-capacity. She also notes that the Bill will give Ontario a chance to be a leader in palliative care. Ms. Gretzky has emphasized that Dan’s Law is simply “the right thing to do”, noting “these are people who don’t have long left”. We will continue to follow the progress of this legislation as lobbying efforts continue and will provide updates as they become available. At Wise Health Law, we provide exceptional guidance on health law matters to regulated health professionals, regulated health professional associations, public hospitals, and other health-care organizations across the province. We monitor trends and developments in health so that we can provide consistently forward-thinking legal and risk management advice to all of our clients. We have offices in both Toronto and Oakville, Ontario, and are easily accessible. Contact us online, or at 416-915-4234 for a consultation.