“The legislation still protects religious values,” said Catholic Health Association of Ontario president and CEO Ron Noble. 

Noble looks forward to Catholic hospitals and other agencies spearheading integration proposals under a new law that would create a single central agency called Ontario Health to oversee $60-billion-plus in annual health expenditures. The legislation would also dissolve the 14 Local Health Integration Networks set up by the Liberals in 2007 and create 30 to 50 “Ontario Health Teams.”

“This will be an opportunity for Catholic health to take leadership, maybe at the team level,” Noble told The Catholic Register. “There may be opportunities for our members to be able to provide a specific scope of services as a Health Team to either a specific population or a specific geographic population or patient care population — particularly in the areas of serving the marginalized and vulnerable in mental health, palliative care, rehab, complex continuing care.”

But health system watchdog Ontario Health Coalition is not so trusting.

“It (The People’s Healthcare Act, 2019) gives the super agency the power to coerce them into this by withholding funding,” said Ontario Health Coalition executive director Natalie Mehra in an e-mail to The Register. “It gives the super agency and the minister the power to order this. It supersedes organizations’ own mandates and missions and trumps the powers of their boards of directors. We are extremely concerned about its impact on equity and on the small, the altruistic, the local health services, since the whole drive of the legislation is to amalgamate, centralize and create bigger and bigger amalgams of health service providers, regardless of unique needs, charitable or altruistic mission and history, and regardless of democracy.”

The new act does preserve language that protects Catholic hospitals from being forced to provide abortions or euthanasia.

“The Minister shall not, (a) issue an order under subsection (1) that unjustifiably, as determined under section 1 of the Canadian Charter of Rights and Freedoms, requires a religious organization to provide a service that is contrary to the religion related to the organization,” reads section 33, subsection 2 of the legislation tabled in the provincial legislature Feb. 26.

But Catholic health care isn’t defined by the things it doesn’t do, said bioethicist Moira McQueen, executive director of the Canadian Catholic Bioethics Institute.

“There are things that we will not do. But we don’t start off with we don’t do this and we don’t do that,” McQueen said. “We have Catholic hospitals because we’re aiming to help everybody.”

The new law gives the Minister of Health the power to send in supervisors who would take over the functions of the board for any reason, including forcing integration plans.

“The Minister may designate persons or entities, or groups, as integrated care delivery systems. The Agency (Ontario Health) may integrate the health system through funding or through facilitations and negotiations. The Minister may integrate the health system through integration orders to health service providers or integrated care delivery systems that are funded through the Agency,” reads the bill currently at first reading in the legislature.

Such powers might run up against the Health Ethics Guide of the Catholic Health Alliance of Canada, which warns that integration plans “bring both opportunities and risks.” Backed by Canada’s bishops, the Health Ethics Guide warns that integration and collaboration plans “should not be completed without the authorization of the diocesan bishop.”

“Obviously we will monitor the risks and mitigate them. Chain of mission is always first and foremost,” Noble said. “At the end of the day, we’re feeling that this could be an opportunity.”

Whatever the law says about integration orders, the Catholic Health Sponsors of Ontario are confident the Minister of Health won’t take over their boards or merge them with other organizations against their will.

“This is about integration of care at the local level…. It’s about integration of care, not necessarily structural integration,” said Catholic Health Sponsors of Ontario president and CEO John Ruetz. “These are going to be provider-led integrations, voluntary at the local level.”

The powers of a new, centralized agency worry Mehra.

“What’s actually written in the legislation is that the minister and the Ford government have given themselves vast new powers to order health service closures, transfers, mega-mergers and the like — including powers to privatize and to facilitate the for-profit privatization of significant parts of our public and non-profit health care services,” said Mehra in a release.

Noble, however, sees an opportunity for hospitals.

“The province has no excess capacity. So they’re not going to be shutting any institutions down, because they don’t have any excess physical capacity,” said Noble. “Our members see this — yes, they can see it as a threat or an opportunity. I think our members are saying we have clear, defined roles and there are certain communities where we can take leadership and there will be other communities where it will be better for us to partner.”

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