Full show: Canadian emergency rooms are in bad shape

0:00Score more with the college branded Venmo debit card and earn up to 5% cash back with Venmo Stash. Got paid back? With the Venmo debit card, you can infinitely access your balance and spend on what you want, like game day snacks, gear, tickets, and more. The more you do, the more cash back you can earn. Plus, there's no monthly fear minimum balance. Sign up now at Venmo.com slash college card. The Venmo mastercard is issued by the Bankport Bank NA, select schools available. Venmo stash terms and exclusions apply at Venmo.me slash stash terms. Max $100 cash back per month. This is the morning to a semi-podcast. Thanks for listening. Well, Canada's emergency rooms are broken. This is what doctors who work at ERs across the country are saying. The big question though is, how do we fix it? And those answers are not easy. We are also going to be talking about what defamation actually means in the legal sense. Everyone's talking about this because of the lawsuit, filed by one Vancouver City Councilor against Mayor Ken Sim,

1:01so we will fill you in on that. And remember the movie Minority Report with Tom Cruise? It's kind of scary, right? Bit of a glimpse into what the future looks like, especially with facial recognition. What we are on the way there is there's still time to put guardrails in place. How much should law enforcement be using facial recognition? It's all coming up on the morning to a semi-podcast. Let's get started. When was the last time that you had to go to the emergency room? It's obviously not a great situation, whether you have to go or even what state those emergency rooms are like. There's a new report from the Canadian Journal of Emergency Medicine that describes Canadian emergency departments as being in a chronic disaster state. How do we fix this? Like, what needs to change? Well, let's talk to Dr. James Rawls, an emergency physician in Ottawa who joins us now. Thank you so much for being here. Thanks for having me, Jimmy. How would you describe our emergency departments? Oh, I've been in emergency medicine practice for more than 20 years,

2:05and I would say Morales probably the lowest I've ever seen it. And would you describe it as that way right across the country? I think so. Yeah, obviously there's some variation, but I'm hearing from colleagues from every province that we're really struggling. Okay, and why is that? What's happening? Well, you know, the pressure on our emergency departments, I don't think is ever being greater. And we have an aging population. We have a lot of people with chronic illness. But within the emerge itself, the pressure is usually caused by a lack of inpatient capacity. So blocked access throughout the hospital and throughout the whole healthcare system. So you end up with the emergency department being sort of jam packed with patients who are admitted, who cannot go home, but they can wait days to get a bed upstairs. And that in turn makes the wait times go through the roof.

3:05Right, so the emergency department is essentially the filter and even the filter is clogged. Well, that's one way of looking at it. Like if you imagine being in a queue for a really popular restaurant in Vancouver, and you look into a window and you see that most of the people inside the restaurant have already finished eating, but they just aren't leaving. They can't leave. That means that the lineup to get inside moves really slowly. And that's what we're dealing with in emergency departments all across Canada. So how do we fix this then? Well, I mean, it's a complicated question. But I think the first thing is we as a society need to ask ourselves, is it important that we have timely access to high-quality emergency care? Would we want a loved one or a neighbor who unexpectedly developed a terrible infection or had a heart attack or was injured? Would we want that person to be rapidly assessed in a well-resourced and a competent emergency

4:12department? And if we do value that, why are we concentrating all the other problems of the healthcare system in our EDs? Why are our nurses and our beds occupied by patients who've already been cared for by us, and they're ready to go to another part of the hospital? Why do we have a single triage nurse who's overlooking a waiting room that may be jammed with 80 patients? And here she's trying to anticipate which one of those patients is going to deteriorate or die while they wait 12 hours for care. The people who arrive in our EDs, they're the highest risk patients in the system because they've just arrived and they might have something really serious going on, but we haven't even assessed them, so we don't know what's going on. And then we make them wait hours and hours for appropriate care. So it's no wonder that sometimes somebody dies while waiting. Let's talk about what's going on at the other parts of the hospital where people cannot be transferred to. Why are those beds so clogged up?

5:16Well, they're suffering from the same problem, but just at another level at their first of all, Canada has a lack of inpatient bed capacity, especially as our population ages, and we have more sick elderly folks living with chronic illness and they need care. But then even after the hospital care has been completed, many patients can't go home. They need post hospital care, so they may need home care, they may need a rehabilitation hospital, they may need to go into a care home. And at every stage of the process, there is access block, there is a lack of ability to move the patient to the appropriate type of care that they need. So I don't blame my colleagues who work on the inpatient services, they're trying really hard too, but essentially all of these pressures within the system are getting concentrated in the emergency department. And so that means that we can't focus on our core mission, which is to provide timely emergency care to people who have

6:18emergencies. Now, Dr. Royal, this very much reminds me that like for years and years, we talked about that silver tsunami in the aging population. And boy, we better do something, but it sounds very much like we never did. And now this is one of the kind of repercussions of that. Yeah, I mean, we have most elderly people, of course, are living healthy, environment lives in the community, but it doesn't take a high percentage of people who have chronic illness and develop complications of chronic illness, or who have falls, or who have dementia. It doesn't take that many people for the demand for emergency services and inpatient care to go up dramatically. So yes, I do think as a society, we have not really prepared for the for the population demographics that we face. Now, the way the system is structured, is that also part of the concern here because I know for the federal government, it's easy for them to say, well, this is a provincial issue.

7:20Yeah, I mean, my colleagues who wrote that paper you refer to in the Canadian Journal of Emergency Medicine, while it is true that we have provincial governments who are responsible for healthcare, I do think there is a role for some sort of national consensus. And my colleagues wrote about this in the article, there is a role for some national leadership, some national standards, some national guidelines on timely access to care. And our organization has put together a huge report on what we think the solutions can look like and can be, and I can only hope the government's role will listen. Okay, but how, when you say the huge impact, what kind of impact, what are these things that you're suggesting? Well, greater accountability through the system would be one important thing. How do we, how do we ensure that somebody's responsible for making

8:21sure that the next patient who arrives, the next ambulance, can be seen quickly in a timely way? Because what tends to happen is that the hospital gets full, the emergency department gets full, and who can solve that in real time? Nobody. There's no, there's no accountability. That's one big step. And of course, you know, greater coordination throughout the system, greater planning for our workforce challenges. There's many, many things that need to be done. Well, we thank you for taking the time to talk to us about that today. Well, thank you so much for your attention to this issue that's, you know, dear to our hearts, those of us who work in the emergency medicine field, and we just want to look after people. And, I hope we can do that. XMA is unpredictable, but you can flare less with EBLESS,

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10:26three years faster. Five million Americans go to work because we make medicines here at home, and not relying on other countries keeps us safe. But China is racing to overtake us. Will we let them or will we choose to stay ahead? When America leads, America cures. Let's tell Washington to keep us in the lead. Learn how at AmericaCures.com. Paid for by Farma. A couple of weeks ago, that was the first time that he tried to mitigate the damage that was done from his comments. Let me back up a little bit because that clearly wasn't enough.

11:29The apologies of Enquirer Mayor Ken Sim has tried to make in light of those wild and unsubstantiated, now also very public allegations against Cope Counselor Sean Orr are not going to be enough. It sounds like what we've heard in the news is that Counselor Orr is now suing Mayor Sim for defamation, which is why a little legal lesson on how defamation works is going to be really valuable. We're going to have that coming up in just a moment. I also just want to go through some of the federal political stuff that we were just talking about. It's always interesting to get people's reaction to a floor crossing, which up until very recently was a rare situation that is not something we often dealt with. Something happened every once in a while. Now it seems like it's happening every week. Yes, a handful of MPs have crossed the floor. All of them until yesterday were conservative MPs becoming liberal MPs. But last night, something different. We found out that Nunavut NDP MP Lori Idlout has crossed the floor

12:35and become now a liberal MP in the Karni government. In fact, just heading into a caucus meeting this morning, the Prime Minister actually walked in with Lori Idlout talked briefly to the press about that. But we were speaking with Don Davies, who's the interim leader of the federal NDP, about the whole situation. He said something interesting. He said that the NDP, they're like, sure, go ahead, cross the floor if you want to. However, they believe that if you do that and you want to change parties, then you have to put that to a vote in your writing, that your constituents should have a say about that. And I think probably most people would agree with you on that. I did get a text message from someone who said, I think that there should be a rule, that if you are going to defect from a party, you have to sit as an independent, or if you want to join another party, you have to have a bi-election. Now, thank you for your comments on that. By the way, and you can also call our buzzline or text at 604-3312-899.

13:37I think that's very reasonable. I think that is a reasonable take to have on this situation, but it's clearly not what's happening here. There are three bi-elections that are coming up on April 13th, and it could mean a majority government without us ever having like a general federal election. So yeah, lots to come on the federal political front. But once again, we're going to turn our attention to municipal politics. So you've been hearing in the news that Vancouver Mayor Ken Sim is now being sued by counselors, Sean, or four defamation. You always hear people say they're going to sue for defamation, right? But what does the law actually say about this? So let's ask Daniel Colesad, who is a defamation lawyer. Thank you so much for being here. Hey, good morning. Do you do you think the public actually understands how the legal form of defamation actually works? No, I think the public has a pretty poor understanding the both of the law and the practical realities of suing some of the defamation. All right, let's start with the law. What does the law say about this?

14:41Geez. So it's a very bold area of the law. It's a relatively complicated area of the law, but at a really high level, you can sue someone. You can take someone to Supreme Court in British Columbia if they have published something false about you, published, meaning they set it to a third party. So if someone goes up to you at a cocktail party and calls you a liar, and no one else hears it, that's not actionable defamation. But if they publish it over a reach out or they say it at a public event that accounts, then it has to be serious. You can't, you know, call someone to jerk and sue them. But if you say they did something illegal, you probably have a cause of action. Okay. That's interesting. So what happens at that point, though? What is like, how easy or hard is this to prove in court? Well, again, it sort of depends on the form of defamation. We talk about libels typically. So a libel is a form of defamation that has been reduced to a permanent form. So that could be any

15:46sort of a text message. It could be an email, anything that's been audio recorded. So those are relatively easy to prove in the sense that something was said. Flanders the other form of defamation, which is spoken defamation, which can be a little bit trickier because by definition, it means it's not permanently recorded. So once you approve that someone's actually defamed you in the sense that they uttered something false, you can have a big fight about meaning. And that might be an issue in this sim lawsuit. What do the words that were spoken or written actually mean to a reasonable listener or a reasonable reader? And then lastly, it's damages. So maybe you've proven something was said and you've proven that it was false so that it's not true. What's that worth? What's the quirk going to do about it? Right, but what do apologies mitigate any of this? They can absolutely. It's not a defense to defamation. So just because someone has said, look, I'm sorry, I shouldn't have

16:48said that. Doesn't mean you can't sue them. You don't have to accept the apology. But it does mitigate damages. So if you've apologized for something you've said and you did so reasonably promptly, Judge is going to look at that and say, you know, what sort of damages are now necessary to compensate you, the plaintiff in this situation for loss of reputation. Daniel, is it rare for this to be, I guess, played out so publicly too? Usually these things, it feels like get settled before we see it, don't we? Yeah, I think semi, it's fair to say that 95% of all civil litigation settles before trial. It doesn't matter what state litigation is expensive. It's uncertain. It's time consuming. It's very taxing on people. Defamation especially, you know, can be easy to settle in the sense that a grieve person, a plaintiff, may be able to orchestrate a better

17:49apology, a more formal apology or a retraction or correction of the record. So I wouldn't be surprised if this lawsuit like most lawsuits is settled in advance of trial. Yeah, what do you find so interesting about this case? I mean, it's interesting in a bunch of different ways. Certainly anytime you mix politics, politics and the law or politics and defamation, you always have the angle that someone may be using litigation for political purposes. It's also interesting to sue and defamation after you have received apology and relatively prompt apology. So it's got a couple different things going forward that make it interesting for defamation lawyers. Are you going to be watching this one closely? I think so. Certainly I've been receiving a lot of phone calls and email to ask my two cents about it. I should say I don't have a horse in the race. I don't know the mayor or council or at all, but this has turned into a real tempest in a teapot quite quickly.

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19:58The first time I ever came across facial recognition technology, it felt like the future had arrived. It seemed kind of cool. Obviously, I was using it on my phone and I thought, well, this is kind of neat. But then, I started to think about that scene from the movie Minority Report. Do you remember that one? Someone with Tom Cruise, where every store he walks into knows exactly who he is and all of the advertising everywhere he goes is tailored directly to him. Then I started to think, well, that's almost where we're at these days. This is where facial recognition is leading to. We're getting closer to that. And law enforcement is vastly increasing how much it relies on facial recognition. The Met Police in London, England, for instance, has said that they scanned more than four million faces last year. Many Canadian police forces admit to using facial recognition as well. So it got me thinking that we spent all of this time

21:00talking about guardrails for artificial intelligence. But what about facial recognition? What do privacy laws say about all of this? Well, Neil MacArthur is a professor of philosophy at the University of Metatoba and joins us now. Neil, thanks so much for being here. It's great to be here. Thanks for having me. Do you think that we underestimate how widely used facial recognition is? I think we do. I mean, I think it certainly talks to me any year because I think it's coming fast. I think right now, certainly in Canada, there are still some limits to how it's being used. But I think those limits are being abandoned. Why do you say that? What do you see? I do see the technology sort of, I mean, the technology is slowly developing, but I think that companies have started, companies especially have started to see its commercial appeal. And so I think they're sort of testing the waters right now. They're sort of seeing how much will tolerate. And so I think we need to decide how much will tolerate. But is that even on people's minds, I wonder? Because we see the ease of it, right?

22:02But are we even thinking at this point about that? I think that's a good question. I mean, because you're right. We see the ease of it. I think if you cross the border, right, you know how much it's bad up the process. Would you rather have your face scanner? Would you rather wait in the line for an hour to talk to a passport person or a customs person? So yeah, I think that these companies are good at showing us that there aren't use. I mean, all this technology has upsides, for sure. So I think that that is true. We're sort of right now where we're in the water and the, we're the frog in the water and the temperature's just going up slowly, but it hasn't hit boiling quite yet. Okay. What point do you think we get to that point of no return? Like we need to start thinking about this now. I think that's absolutely right. I mean, I think that the problem is our laws aren't ready for this. And yeah, you mentioned law enforcement. Law enforcement is definitely looking at rolling this out. They haven't, I think, figured out what they can, you know, what the limits are yet because there haven't been a lot of court cases, a lot of laws. And then companies certainly like meta are ready to deploy this as they think that they can

23:04problem. Is it too late to do this, though? Like how can we put in guard rails in place at this point? So you're talking about three things. You're talking about people using it. You're talking about companies using it. You're talking about governments using it. And I think that we need laws to govern all three of those uses. And so I don't think it's too late. I think that, you know, we can, we can pass laws in fairly short order if we have to. And I think that, you know, just building biometric data into our privacy laws should not be that difficult if we have a political will. Okay. But I see, I think you lose a lot of people when they go biometric data. What's that? This sounds complicated. So what would that look like? So basically, first of all, it would say when law enforcement can scan your face, can they, and what counts as an expectation of privacy? I mean, traditionally, we've had this idea that you're protected if you're in a private space and not in a public space. But that's because, you know, you couldn't just scan someone's face and tell who they are. So I think we need to,

24:05to say law enforcement can or can't use it in these contexts without a warrant. And you know, we need to say, you know, having this kind of database. So right now, they're using databases of, you know, known offenders. And we need to ask, well, are we going to let them just have a general database of everybody's face that they can use? If not, we need to put a lot of friends in doing that. Is that what they're doing? Is that, Neil, is that what they're doing right now? Do you think law enforcement has databases of, like, non, like, non-criminal people faces that they've scanned? I think they don't right now. I think there are companies that want to sell it to them. I think that right now, I think law enforcement knows that there are constitutional limits and there are legal limits. But we'll, we'll see. I think they're going to test those limits. And so, I think we need to clarify them. I also don't think, yeah, I don't think that the technology is quite there for, like, a general, all-purpose database of everybody. Clearview AI tried to do that using the internet and they had to pull out a Canada because it did end up violating Canadian

25:10privacy laws. So, so they haven't done it yet, but I think we need to be clear that we don't want. Oh, yeah. So, just so people know then, when in this country, when is it legal for law enforcement to scan your face? Well, right now, they're supposed to have, you know, that we have a constitutional protection for against unreasonable searches. So, so they're supposed to have some cause for, for, you know, wanting to collect your data. They're supposed to have some, you know, lethal expectation that you are a suspect or, you know, that they have some other good reason for doing that. And so far, right now, again, they don't have a, the database that they have are supposed to be ones where, you know, there's a reason, there's a good reason for them to have that data that you're someone who is a, you know, a suspected offender. Right. It sounds like a bit of a patchwork, though, that you don't know what each force is doing. No, that's exactly what it is. It's a patchwork in terms of each force in terms of each province. You know, we have a,

26:11we have a charter, obviously, but then we have federal and provincial privacy laws that don't always line up. Quebec since the best right now, they're the only ones that explicitly protect facial data. But, but I think, yeah, I think the others have to step up this one. Okay. So is there anything we can do with this point to protect ourselves? In terms of protecting your face from being scanned, I mean, if you think about, you know, ring doorbells or metaglasses or some of the other things that might scan you in your daily life, unfortunately, right now, there isn't as an individual. I don't think there's much you can do this is why we need laws because, you know, unless you want to wear a, wear a mask around all day or something like that, I don't think that you can actually protect yourself very easily. I mean, you know, these ring doorbells are everywhere. Yeah, um, metaglasses are starting to turn up everywhere. So all these sort of points of contact that we might have with facial recognition are just spreading and spreading. So I think individuals were, were powerless. I think as as a society, we're very powerful if we step up. Unless we step up. Do you even see this on the government's agenda at this point? You know, I think this is one where I'm fairly off to

27:14mystic. I think that, um, I think that there's enough. I think, I think lawmakers are worried just as we are. I think that they're not, they're not exactly gunning for this technology. I don't think there's a powerful law before it right now. So, you know, I, I think that actually there, there could be, it could be some legal change for sure. Well, it's hopeful. Neil, thank you so much for your time. It's always a pleasure. Thanks so much. That's the mornings with Simi podcast. Thanks for listening. Don't forget to look for us on CuriousCast, Spotify, Apple, or anywhere you find your podcast. That's a nice word, partner.