Toronto mayor John Tory brings up the idea of road tolls and Queen’s Park debates it for days. Activist MPPs in both the Liberal and New Democratic parties have offered bills to exempt Toronto, and only Toronto, from having its council decisions overturned by the Ontario Municipal Board. Greater Toronto has its own big transit authority in Metrolinx, and its own big hunk of the Liberal government’s infrastructure fund.
While it’s irritating enough for residents outside the GTA to see the Big Smoke get outsize attention, what’s even worse is that Toronto-centric policymaking can have unintended consequences in other parts of the province.
Case in point: Toronto also got an administrative headache over paramedic services solved years ago, in a way that continues to have unexpected and potentially damaging effects in the Ottawa Valley.
Big-city, regional, and county governments run paramedic services in Ontario but ambulances cross municipal boundaries all the time. The nearest ambulance answers an emergency call no matter where it is, and it carries a patient to the nearest suitable hospital, no matter where it is.
It’s called “seamlessness,” a rule enforced by the provincial government, and meant to ensure that if you’re having a heart attack or have fallen off a roof, a jurisdictional boundary doesn’t keep the closest paramedics from zooming your way. The province pays half the cost of municipal paramedic services and seamlessness is one of the conditions it imposes in exchange. If you’re sick or hurt, it makes a lot of sense.
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Until 2008, the province let municipalities bill each other for the ambulance services they used this way.
It took some math, but not very difficult math: each city or county worked out the average cost of its paramedic calls, counted the number of calls it covered in a neighbour’s territory, and multiplied the number of calls by the average cost of a call to figure out what it was owed. Whichever municipality used more cross-border ambulances cut a cheque for the difference.
But in and around Toronto, that simple exchange got extremely complicated. Multiple municipal paramedic services there take patients from many relatively dense suburbs to many different hospitals in multiple municipalities. They’d cross borders for pickups and transports all the time.
They’re also dispatched by separate centres in Toronto itself, in Mississauga in the west, in Barrie in the north, and in Whitby in the east. The rest of the province doesn’t have that density of population, hospitals, or dispatch centres.
Working out who owed what to whom among Toronto, Halton, Peel, York, Durham, and even beyond wasn’t impossible, but it was a lot of trouble. An advisory committee convened by the province, whose main job was working out how to speed up response times to calls, recommended scrapping that part of the system.
So in 2008, the provincial government changed the rule about sending bills for paramedic services rendered. Municipalities were still allowed to make payment deals with each other if they wanted. If they didn’t, “provider” municipalities could no longer send bills to “recipient” municipalities — at least, not with any expectation they’d be paid.
In Greater Toronto, that cleaned things up. In eastern Ontario, it made a mess.
"It is a real problem every day,” says Michael Nolan, the paramedic chief in Renfrew County, northwest of Ottawa. He’s furious that Ottawa uses his ambulances and, thanks to the province, doesn’t have to pay for them.
The City of Ottawa had 10-year deals with each of the counties around it to pay fixed prices for cross-border ambulance services, ranging from about $200 to $275 a call. At the end of the year, they’d count up the cross-border calls and whoever had needed more paid for what they’d used.
Those agreements all ran out at the end of 2015.
"They’re acting now like the offended services, like they didn’t know about this,” says Anthony Di Monte, Ottawa’s paramedic chief. That is, aggrieved jurisdictions are treating the dispute as primarily financial (which, from their perspective, is fair, since they are the ones paying up, whatever the health-care benefits to patients elsewhere or to the system overall). "They knew a long time, and as an administrator, I’m doing my planning, I would let my overseers know and work it into my planning process."
According to figures kept by the counties around it — Renfrew, Lanark, Leeds-Grenville, Stormont-Dundas-Glengarry and Prescott-Russell — Ottawa called in their ambulances on 376 occasions more than they used Ottawa ambulances in the first six months of 2015.
In the first six months of 2016, once Ottawa had stopped having to pay for those calls, it was 653 times — a 58 per cent increase. At times, Nolan says, half the ambulances that are supposed to be serving Renfrew, a sprawling county of 7,400 square kilometres, are answering calls in Ottawa.
"Yes, there’s legislation, but how you apply it and practise it is important,” says Michel Chrétien, the paramedic chief in Prescott-Russell, east of Ottawa, which has supplied more paramedics to Ottawa than anyone else. Nobody expected solving an administrative headache for the Greater Toronto Area would mean another big city elsewhere, like Ottawa, would start free-riding on its rural neighbours.
Ottawa admits its paramedic staffing hasn’t kept up with demand for services. In 2017 city council is boosting its paramedic budget to catch up; Di Monte's on a hiring kick. Maybe everything won’t be solved right away but the balance should tilt back. The health ministry says it’s every municipality’s job to make sure it has enough paramedics on the street to serve its own people, and it’s examining Ottawa’s paramedic deployments to see what can be done.
And besides, Ottawa politicians say, these jurisdictional issues go both ways, and can balance out: people on the city's outskirts use its roads and transit system, and Ottawans pay for paramedics through their provincial taxes.
Easy for you, say the neighbouring counties. You’re getting our ambulances.
"Our responsibility is to care for our community first, and to be able to work collaboratively with our neighbours," says Renfrew’s Nolan, "so that if they need help, we do that it concert.”
David Reevely is a columnist for Postmedia in Ottawa.
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