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Is the Toronto city workers' strike hurting public health?

The growing piles of garbage strewn across Toronto aren't the only detrimental effect of the city's public servants' ongoing strike, according to two recent, unsettling stories in the Toronto Star.

Last week, the Star's Theresa Boyle one infection-control expert's concerns that the prolonged absence of striking Toronto Public Health Unit are hurting the city's capacity to prepare to fight the expected resurgence of the H1N1 flu pandemic this fall.

"The bottom line is more people will die" if the striking workers remain on the picket lines, warned Dr Allison McGeer, a microbiologist and the head of Mount Sinai Hospital's infection control divison.

Although pandemic planning is an essential service and therefore protected from the strike ("Planning for a pandemic in the context of the current H1N1 outbreak is something we identified as a critical service to be maintained during the strike, so non-union staff have been continuing with our planning efforts," explained the city's chief medical officer of health Dr David McKeown) Ms Boyle heard from unnamed sources in the public health department that some officials share Dr McGeer's concerns.

And then, this Thursday, another story: sexually transmitted infections and unwanted pregnancies may rise as a result of the strike, reporter Megan Ogilvie. "Sexual health clinics reduce the amount of disease in the community and we are less able to do that now" due to the strike's impact on the city's public health force, said U of T assistant professor of nursing LaRon E Nelson.

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Airlines must pay MDs for non-emergency mid-air care: judge

A Montreal doctor has won a small-claims lawsuit against Air Canada, a victory that he hopes will compel airlines to pay physicians for their aid in non-emergency cases during flights.*

Kept up all night tending to patients on a flight to Paris, Montreal family physician Henry Coopersmith was insulted by Air Canada’s offer to compensate him for his effort with what he considered a paltry number of frequent flier miles. His flight was ruined, he had explained to the company, and he wanted Air Canada to give him two replacement tickets of equivalent value. Air Canada refused. When one of their lawyers responded to his complaints by writing that he was ethically obligated to care for the passengers (one had mixed alcohol with sleeping medications but was fine, another had a headache, and a third was having a panic attack) and therefore not entitled to anything beyond a small token of the company’s appreciation should they decide to offer it, Dr Coopersmith decided to sue.

The case -- surely one of the most complex and most consequential small-claims court cases decided in recent years -- wrapped up last month when Justice David L Cameron ruled largely in favour of Dr Coopersmith, awarding him $1,000. Dr Coopersmith believes the decision could establish legal precedent that would require airlines to pay doctors for their medical work and for any loss of enjoyment of the flight or their travel as a result of the flight.

“I am exceptionally pleased with it,” Dr Coopersmith told Canadian Medicine. “It’s a real victory with respect to protecting health professionals, both with protecting their legal and ethical obligations.”

But don’t get him wrong, he says: he’s not some “greedy doctor” trying to “gouge” the airline, as one Canadian aviation website described him. Dr Coopersmith has no quibbles with doing assessments of patients to determine if they need emergency care, or with providing Good Samaritan care to patients in genuine emergencies. But if doctors are roused from their mid-air slumber (as he was after he had initially volunteered to evaluate the sick patients and determined there was no emergency) to deal with non-emergency cases that the airline’s employees can take care of, he believes they should be compensated for their time and effort.

His reasoning is not based just on a sense of what “reasonable” limits to asking for a doctor’s help might be (he asks whether doctors should be expected to treat people’s headaches while relaxing on the beach). His position is also predicated by an important legal concern.

During his research for the case, Dr Coopersmith discovered something that hadn’t been communicated well to doctors before: the Canadian Medical Protective Association, which provides malpractice insurance for Canadian physicians, will not extend legal protection to doctors who treat patients for non-emergency cases on airplanes. ("Nobody knows that," says Dr Coopersmith. "I sent them this case and suggested they advertise the distinction.") So not only was Air Canada asking Dr Coopersmith to volunteer his expertise, they were also asking him (albeit unwittingly) to expose himself to significant liability.

This case has established a legal precedent, Dr Coopersmith argues. If doctors are explicitly asked to “volunteer” their skills to treat non-emergency cases in airplanes, they now have recourse to be paid for their work. “They can just send a bill,” says Dr Coopersmith. However, the precedent he believes was established has not yet been tested in court and is complicated by the fact the judge took pains not to generalize about other doctors' work in his ruling.

An Air Canada spokesperson told Canadian Medicine that the company is “studying the decision” and reviewing their options. It’s not possible to appeal small-claims court decisions, but the company could potentially request a judicial review. The spokesperson says the company has no plans to change its policy about providing compensation to doctors who provide care to passengers, but Dr Coopersmith says their policies and procedures will have to be brought in line with the law.

To read the full text of Justice Camerson’s decision, click .

Photo: Shutterstock

*This article has been corrected. The original version implied that Justice Cameron's ruling had indeed established new precedent, but that is not yet clear. Canadian Medicine apologizes for the error.