TABLE OF CONTENTS

REPORTS OF THE STANDING COMMITTEES

AND OTHER COMMITTEES

As Considered by

The Council of the City of Toronto

on March 2, 3 and 4, 1999

EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

REPORT No. 2

1Restrictions of Ambulance Access to Hospital Emergency Departments

2Regulation and Licensing of Medical Transportation Services

3Transfer of Surplus/Decommissioned Ambulances to St. John Ambulance

4Schedule of Taxicab Inspections

5Amendments to Toronto Licensing By-law No. 127 - Driving School Prohibited Area

6Collision Reporting Centres -Legal Proceeding Commenced by Allstate Insurance Company of Canada, et al.

7Rationalization of Six Existing Committees and the Task Force on Community Safety

8Other Items Considered by the Committee

City of Toronto

REPORT No. 2

OF THE EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

(from its meeting on February 9, 1999,

submitted by Councillor Dennis Fotinos, Chair)

As Considered by

The Council of the City of Toronto

on March 2, 3 and 4, 1999

1

Restrictions of Ambulance Access to

Hospital Emergency Departments

(City Council on March 2, 3 and 4, 1999, amended this Clause, by adding thereto the following:

"It is further recommended that the Provincial Minister of Health be requested:

(1)to investigate allegations that some hospitals are placing their Emergency Wards on Redirect Consideration and/or Critical Care Bypass without full justification;

(2)to establish, monitor and enforce a Redirect Consideration and Critical Care Bypass policy which is consistently applied in every hospital; and

(3)not to close the Emergency Ward of the Queensway Hospital until this matter has been resolved.")

The Emergency and Protective Services Committee recommends that:

(1)Council reaffirm its support for the Toronto Paramedic Service being the primary service for medical emergencies in the City of Toronto; and

(2)the Mayor be requested to meet with the Premier of Ontario to discuss means of reducing the rates of Redirect Consideration and Critical Care Bypass at Toronto's emergency rooms.

The Emergency and Protective Services Committee reports, for the information of Council, having:

(a)requested Councillor Dennis Fotinos, Chair of the Emergency and Protective Services Committee, to invite the Provincial Minister of Health to appear before the Committee in order to provide a briefing on the Province's efforts to reduce the increasing restriction of access to hospital and emergency wards;

(b)requested the Commissioner of Works and Emergency Services, in conjunction with the General Manager, Toronto Ambulance, to convene a one-day meeting of representatives from Hospitals, the Canadian Medical Association, the Ontario Nursing Association, the Canadian Union of Public Employees, Locals 79 and 416, and other interested medical groups to:

(i)discuss the problem of Critical Care Bypass and Redirect Consideration of hospitals; and

(ii)review protocols for addressing these situations at the various hospitals;

and that Members of the Emergency and Protective Services Committee be invited to participate in the proposed one-day meeting; and

(c)referred the following motion to the Budget Committee for consideration:

"That Council further support the principle of parity between the Ambulance, Fire and Police Services."

The Emergency and Protective Services Committee submits the following report (January 18, 1999) from the General Manager, Toronto Ambulance:

Purpose:

To provide information to the Emergency and Protective Services Committee on the increasing restriction of access to hospital emergency departments.

Funding Sources, Financial Implications and Impact Statement:

There are no immediate financial implications or requirements related to this report.

Recommendation:

It is recommended that this report be received for information.

Council Reference/Background/History:

The Central Resource Registry (CRR) was established several years ago under the direction of the Hospital Council of Metropolitan Toronto and is currently administered under Criticall Toronto. The CRR allows hospitals to indicate their bed availability status to facilitate inter-hospital transports and permits hospitals to indicate to the ambulance service that they are experiencing temporary difficulties in accepting additional patients. Hospitals can request either that only critically ill patients be brought to the emergency department, Redirect Consideration (RDC), or that no patients, except for scheduled transfers, be brought to the emergency department, Critical Care Bypass (CCB). The definitions of these categories were established by committees which included wide representation from emergency departments and other hospital representatives. Monthly reports of the utilization by Toronto area hospitals are provided to all participants. A number of reviews regarding issues related to emergency department access have included reference to the increasing utilization of restricted emergency department access to ambulances. The most recent of these was the report prepared by the Emergency Services Sub-Committee of the Ontario Hospital Association at the request of the Minister of Health following the dramatic increase in emergency department restricted access in the winter of 1998.

Comments and/or Discussion and/or Justification:

The trend to increasing utilization of RDC and CCB by Toronto area hospitals has continued through 1998. In previous years, a number of hospitals have endeavoured to reduce their utilization of RDC and CCB with inconsistent and usually temporary success. Some hospitals have by policy chosen to not utilize either or both statuses, for specific periods of time or on an ongoing basis. For example, the Hospital for Sick Children, as the major tertiary pediatric facility in the Toronto area, has never used either status. The monthly averages for RDC and CCB utilization may not therefore accurately reflect the depth of the problem.

Graphs comparing 1996, 1997 and 1998 CRR utilization provided by the Central Resource Registry are included as Attachment No. 1. These display the continuing increase in restriction of access to ambulances. The tables in Attachment No. 2 demonstrates the level of utilization of CRR by Toronto and area hospitals in ranked order during the months of September, October and November from 1997 and 1998.

The hospitals in the northwest of the City and the adjacent hospitals in Mississauga and Brampton are having the greatest current impact on Toronto Ambulance. The five fully active emergency departments restrict access to their emergency departments 46.2 percent of available hours. Hospital closure in this part of the City has included the closure of the former Northwestern Hospital and the partial closure of the emergency department of the former North York Branson Hospital. The difficulties being experienced in the northwest are expected to be further impacted when the former Queensway Hospital begins to partially close its emergency department in the coming months. Patients from the northern part of the Queensway catchment area may be transported to hospitals in the northwest area placing a further demand on their resources.

Similarly, patients from the eastern portion of the Queensway catchment area may be transported to St. Joseph's Health Care Centre rather than the Mississauga Hospital. St. Joseph's currently restricts access to ambulances over 30 percent of its hours of operation. The change in patient destination resulting from the Queensway closure may result in difficulties in the southwest paralleling those in the northwest.

The hospitals east of Yonge Street, on average, restrict ambulance access more than 20 percent of available hours. This may be further increased when the Wellesley Hospital closes its emergency department. Patients are likely to be transported to St. Michael's, Sunnybrook or the East General hospitals, possibly increasing their restricted status.

Conclusions:

Hospital restructuring appears to be one of the factors contributing to the increasing restriction of ambulance access to Toronto and area emergency departments. Additional factors have been addressed by the Ontario Hospital Association report and others. Data from the past three years indicates an increasing problem. The northwestern part of the City is currently the area of greatest impact on the delivery of ambulance services. The ability of Toronto Ambulance to provide timely patient care and transport may be compromised unless system improvements are made.

Contact Name:

Ron Kelusky

Tel: 397-9241/Fax: 292-2115

(A copy of each of the attachments referred to in the foregoing report was forwarded to all Members of Council with the agenda of the Emergency and Protective Services Committee for its meeting on February 9, 1999, and a copy thereof is on file in the office of the City Clerk.)

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The Emergency and Protective Services Committee reports, for the information of Council, also having had before it during consideration of the foregoing matter a communication (February 8, 1999) from Ms. Anne Dubas, President, Canadian Union of Public Employees, Local 79, in connection with the foregoing matter.

The following persons appeared before the Emergency and Protective Services Committee in connection with the foregoing matter:

-Mr. Ron Kelusky, General Manager, Toronto Ambulance, and gave a presentation with respect to Health Care Restructuring, Emergency Department availability, system utilization and staff impacts, and options to be considered; and

-Ms. Roberta Scott, Toronto Paramedic Association.

2

Regulation and Licensing of Medical Transportation Services

(City Council on March 2, 3 and 4, 1999, adopted this Clause, without amendment.)

The Emergency and Protective Services Committee recommends:

(1)the adoption of the following report (January 18, 1999) from the Commissioner of Works and Emergency Services; and

(2)that representatives of the Toronto Ambulance Service Staff Association, the Canadian Union of Public Employees, Locals 79 and 416, and the Operators Association be invited to assist in the development of the proposed regulations:

Purpose:

To advise Toronto Council of Bill 86, 'An Act to provide for better local government by updating and streamlining the Municipal Elections Act, the Municipal Act and related statutes'. This legislation empowers municipalities, at their option, to effect both service standards and regulation of Medical Transportation Services. Despite Medical Transportation Services being defined in legislation, without such municipal regulation, providers are free to operate without consistency or measurable objectives for public safety. In addition, through Toronto Licensing, as with other vehicles offered for hire in the municipality, consideration may be given to licensing the owners and drivers of medical transportation vehicles.

Funding Sources, Financial Implications and Impact Statement:

Licence fees set at cost recovery levels for medical transportation services would have a neutral funding impact on Toronto Licensing. However, there will be resource implications to implement and sustain the processes of licence issue and enforcement. At least thirty medical transportation services are in operation Province-wide, with approximately ten to twelve operating in the Greater Toronto Area. Regulating and licensing these providers will ensure a safe and acceptable level of service and an appropriate alternative for citizens requiring transportation by other than ambulance services as defined under regulation.

Recommendations:

It is recommended that:

(1)the City Solicitor and Commissioner of Urban Planning and Development Services, in consultation with Toronto Ambulance, define and construct regulations and set standards (see attached draft guidelines) that will regulate Medical Transportation Services within Toronto;

(2)a process of public meetings and focus groups be established in the community to provide the public and other service providers and stakeholders with an opportunity for input and comment on the regulatory, licensing process, or formal business;

(3)the City Solicitor evaluate the Municipality's risk/obligations/options around the regulation/licensure of this new transportation sector; and

(4)the appropriate City officials be vested with the necessary authority to give effect thereto.

Council Reference/Background/History:

The omnibus legislation Bill 86 received Royal Assent on December 19, 1996. Part X.2, section 191.6(1) amends the Highway Traffic Act, empowering municipalities to regulate Medical Transportation Services by setting standards in relation to the operation of those Services. Since 1994-1995, twenty eight to thirty Medical Transportation Services have come on-stream across the Province with ten to twelve operating in the Greater Toronto Area. Section 191.6(3) provides for fines of not more than $10,000.00 on conviction of contravention of such a by-law. Section 191.7 ensures that the Minister of Transportation may make regulations designating the types of services and vehicles.

Furthermore, Part III Section 59(10) of Bill 86 also amends the Ambulance Act as follows:

Ambulance Act:

"Ambulance" means a conveyance used or intended to be used for the transportation of persons who,

(a)have suffered a trauma or an acute onset of illness either of which could endanger their life, limb or function, or

(b)have been judged by a physician to be in an unstable medical condition and to require, while being transported, the care of a physician, nurse, other health care provider, emergency medical attendant or paramedic, and the use of a stretcher;

"ambulance service" means a service, including the service of dispatching ambulances, that is held out to the public as available for the conveyance of persons by ambulance.

(A)Comments and/or Discussion and/or Justification:

Impacts:

(a)The new definitions contained in the Bill 86 Ambulance Act amendments (see above). If all three ambulance transport criteria, i.e., unstable, stretcher required and patient in need of an escort were applied literally, this could polarize more requests for non-emergency ambulance service to the medical transportation sector.

(b)Declining non-emergency call volumes. Note: 1994 non-emergency call volumes decreased significantly. It is feasible that 5,000-6,000 per annum have moved to the Medical Transportation Services sector since their inception.

(c)Ambulance service must maintain its 'ready status' for emergency response. Although hospitals prefer to use ambulance services because it is less costly, tight time demands for diagnostic and other specialized procedures see them opting to use Medical Transportation Services whom they perceive as more sensitive and responsive to those non-emergency but time-sensitive needs.

(d)More frequently Ambulance Call Reports are being signed-off as non-essential by the medical community, which in turn results in the generation of a $240.00 billing.

(e)More uninsured or ineligible ambulance billings of $240.00. Due to the more specific new Ambulance Act definitions, more calls for service provided by ambulance but deemed ineligible for Ontario Health Insurance co-payment could cause a further shift of non-urgent call volume (possibly 5-15 percent) to the Medical Transportation Services sector as their average local transport billing rate by comparison is $60.00-$80.00. Many institutions are not aware that Medical Transportation is unlicensed/unregulated.

(f)Billing issues aside, non-emergency and non-essential calls, traditionally part of the ambulance service mandate, could shift to Medical Transportation Services. Already, they are perceived as faster (anecdotally) than the ambulance response to non-urgent transportation requests

(g)In an environment of increasing emergency call demand, overall acuity of illness and static health care funding envelopes, the option to use Medical Transportation Services could be seen as more attractive by institutions and the general public thus increasing pressure on governments and institutions to fund this alternative level of service.

(h)For inter-institutional transfers, the normal ambulance fee of $45.00 is waived. Already, Medical Transportation Services bills submitted as third party claims to medical insurers are frequently paid, indicating that no real distinction is drawn (at least by insurance providers), between the two types of service.

(i)From an institutional sector perspective, Medical Transportation Services represent an optional/partial solution to blocked acute care beds and missed 'time-sensitive' medical/diagnostic appointments or subsequent sub-acute or rehabilitation admissions elsewhere in the system. Development of regulations and standards would enfranchise the medical transportation sector as bona fide service providers.

(j)Aging population/demographic demands will inevitably increase pressure on the land ambulance system to perform more essential non-emergency services.

(k)Future co-shared opportunities might include non-emergency billing or fee for service, apportioned between Institutions, Municipalities, Patients and the Provincial Government.

History:

Since 1994-1995, 28-30 Medical Transportation Services have come 'on-stream' across the Province with 8-10 operating in the Greater Toronto Area.

Actions:

(a)Draft Ministry of Health Medical Transportation Services Safety Guidelines March 21, 1997 (attached).

(b)Background sent to Ms. Shirley Mathi at Legal Services and Ms. Carol Ruddell-Foster at Toronto Licensing on June 10, 1998, for review and consultation. Note from Ms. Shirley Mathi: TTC have exclusive mandate for transportation in Toronto.

(c)Toronto Fire Department charge $300.00 for 'assist' calls from Medical Transportation Services providers. See Toronto Fire Department Advisory May 25, 1998 (also attached) from Chief Speed.

Types of Patients/Client Eligibility:

Medical Transportation Services: Patient must be in stable condition but unable to tolerate sitting or standing, thus precluding wheelchair transport option. Could include frail, elderly, especially without own wheelchairs.

(B)Discussion: Cross-Sector Community Transportation Dispatch/Brokerage:

Ambulance service, medical transportation services, specialized accessible transit (including Wheeltrans) and community transportation (not for profit and volunteer) resources, accessible and otherwise, represent the continuum of transportation options available for medically necessary, through non-essential services available in the community.

A suggestion originating with the Toronto Social Planning Council in 1997 is that "a group investigate shared dispatching" potential between Wheel-Trans, Toronto Ambulance and other selected agencies (e.g,. Canadian Red Cross).

Low-priority requests for transportation service received by Toronto Ambulance Communications Centre could, subject to the necessary protocols, be redirected elsewhere within this continuum. Specifically, per Bill 86, those patients not requiring all three ambulance transport criteria, i.e., patient stable, stretcher not required and not in need of an escort (as defined, e.g., by a physician, other health care provider EMA, paramedic etc.)

In theory, it would be possible for one agency with the appropriate technical platform and expertise to receive and devolve all types of transportation requests to the appropriate level of resource, e.g., the 9-1-1 emergency number, or similarly in the private sector 967-1111 central number for pizza. Devolution would of course be contingent upon the necessary education, orientation of users/stakeholders and their "top-down" buy-in, together with an elective transportation algorithm crafted for public consumption and education.

The structure of this model would also need to demonstrate flexibility and encourage acceptance by the partners, including institutions, i.e., by providing dedicated transfer co-ordinators to optimize ''bed to bed" or "door to door" service. This would facilitate single or block bookings for groups requiring transportation service and access to all categories of service provider, on time without overlap or duplication.

Regulation of medical transportation services, followed by focus group sessions including the community transportation sector, accessible transit and out-of-hospital providers would represent a definitive first step in the development of scope of practice guidelines, public information and education material design and distribution to raise public awareness of and how to access the transportation options available.

Billing, cost-sharing and cost-recovery mechanisms, geared to the level of service provided, would be a necessary next step. Other communities, Upper Tier Municipalities are investigating the feasibility of setting the fees for medical transportation e.g., at $45.00. This would narrow the disparity between fees charged.

(C)CTAP:

This one time inter-ministerial program started out with $3 million, at < $50,000.00 per approved project and approximately 60 proposals from community groups around the Province. The objective, through the collaborative efforts of the inter-sectoral working groups, is to improve local access to transportation through more efficient and effective use and co-ordination of currently available resources.

Ongoing Community Transportation Action Program (CTAP) projects have shown that new partnerships are resulting in better utilization of elective transportation resources overall. Most have aimed at matching the right client with the right resource to achieve the best possible efficiencies, price and quality.

The CTAP Program, extended July 13, 1998, by Transportation Minister Tony Clement, now expires September 1999. Sustainability of services may then be in question. The Ministry of Health Long Term Care Division does provide transportation funding, i.e., the Long Term Care Division funds many agencies and institutions in the Province to provide transportation services to their own residents and clients. No municipal funding is received. Some not for profit sector agencies and volunteer transportation services are also variably dependent on grants and donations to help provide these services.

(D)Conclusions:

The provincial government's decision to devolve regulatory authority for Medical Transportation Services to municipalities may represent an opportunity to enhance public safety by setting standards for the safe operation of those services already operating within the community.

The City of Toronto, by virtue of its licensing authority could opt to impose appropriate minimum standards to ensure that the safety of medical transportation vehicles, adequate insurance coverage and driver qualifications are both met and maintained.

Contact Name:

R.L. Kelusky - 392-2200

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Medical Transportation Safety Guidelines Project

Definition for Purposes of Regulation:

"For the purpose of Part X.2 of the Act, a medical transportation service is a service:

(a)which is not licensed as an ambulance service under the Ambulance Act;

(b)which charges a fee or receives public or private funding;

(c)which offers to the public a combination of transportation and provision of care for the passenger's individual health care needs."

Guidelines

(A)Service Providers (the person or persons who provide direct service to the client - where a service uses one service provider as both a driver and health care escort all of the following guidelines apply to that provider).

All:

(1)Must be able to speak English.

(2)Must be free of those communicable diseases which have been determined by the Medical Officer of Health to be easily transmitted to the clients of the service through the normal interaction between the driver and the clients.

(3)Must provide a Criminal Record Search.

Driver:

(4)The driver of a medical transportation vehicle must have a current and valid driver's licence for that class of vehicle as specified in the Highway Traffic Act.

(5)Must have the skills necessary to carry out the driving tasks associated with the type of vehicle being used and the needs of the clients being transported.

Health Provider:

(6)Must possess the knowledge, judgment, and skill to recognize a medical emergency and render CPR and first-aid at an advanced level as defined by Federal or Ontario Ministry of Labour standards.

(7)Must have the training and credentials necessary to provide the level of care held out to the public by the medical transportation service.

(B)Client Care:

(1)The medical transportation service must not commence transportation of a client who requires an ambulance and must immediately contact ambulance dispatch in order to determine an appropriate course of action if it appears that a client has become or is becoming medically unstable during transport. (See Ambulance Act)

(2)Where there is reason to believe that a client is confused or disoriented, or is likely to require immediate care or assistance the client must be left in the care of an apparently responsible adult who is made aware of the problem.

(C)Communications:

(1)The person or persons providing service on the medical transportation vehicle must be able to contact ambulance dispatch and/or 9-1-1 (where it exists) from the medical transportation vehicle while a trip is in progress.

(2)The person or persons providing service on the medical transportation vehicle must know the telephone number for reaching ambulance dispatch in all areas of operation.

(3)The person or persons providing service on the medical transportation vehicle, upon arriving at a facility, must notify a member of that facility's staff that the client has arrived and the status of the client.

(D)Lifting and Moving Equipment for Clients:

(1)Wheelchairs, ramps and lifting devices provided by the medical transportation service must be maintained in good working order and must conform to Canadian Standards Association.

(2)Stretchers provided by the medical transportation service must be maintained in good working order in accordance with the Original Equipment Manufacturers specifications.

(3)Stretcher retention systems must be matched to the stretcher being used and must be maintained in good working order according to the Original Equipment Manufacturers specifications.

(E)Vehicle:

All:

(1)Must successfully complete annual safety inspections.

(2)Conform to the Motor Vehicle Safety Act.

Wheelchair:

Must conform to Canadian Standards Association standard CAN3-D409-M84 (Motor Vehicles for the Transportation of Physically Disabled Persons).

Must conform to Regulation 629 (Vehicles for the Transportation of Physically Disabled Passengers), Ontario Highway Traffic Act.

Stretcher:

(1)Easy loading of stretcher clients by means of a door or doors at the rear of the vehicle, and easy loading of ambulatory clients by means of a door or doors on the right side.

(2)Any door opening into or out of the client compartment shall be designed and equipped to permit such door to be opened from the inside of the vehicle, and such opening mechanism shall:

(a)contain instructions for the opening thereof on or adjacent thereto; and

(b)be designed to prevent inadvertent opening.

(3)A lap-type safety seat belt conforming to the standards prescribed in the regulations under the Motor Vehicle Safety Act (Canada) shall be provided for each seating position in the vehicle, and such belt locking mechanism and mounting device shall be properly maintained and in good working order.

(4)Adequate temperature regulation and ventilation.

(5)Interior lighting adequate for the care of clients.

(6)A rear flood light designed and attached to light the area immediately to the rear of the ambulance automatically upon opening of the rear door or doors.

(7)Storage for equipment to prevent or minimize projections and sharp edges, and to keep such equipment readily available for use.

(8)For the placement and transport of at least one sitting client when only one stretcher is in use.

(9)For seating in the client compartment for at least one service provider with one such seat at the head of the stretcher client.

(10)Have an interior that is free of any sharp projections that may constitute a hazard to passengers.

(11)Have permanently bonded to the floor in the client compartment in the aisle and on the steps, floor covering that is fire-retardant, skid-resistant and wear-resistant rubber or equivalent material.

(12)Have yellow or white step nosings.

(13)Conform with Canada Motor Vehicle Safety Standard 302 regarding flammability.

(14)Be equipped with at least one dry-chemical-type fire extinguisher:

(i)bearing the label of a recognized testing agency;

(ii)showing a rating of not less than 2-A; 10-B; C; and

(iii)equipped with a pressure gauge indicating that the fire extinguisher is adequately charged.

contained in the extinguisher manufacturer's bracket.

(15)Be equipped with an axe or clawbar.

(16)Be equipped with a unitized first aid kit in a sturdy, dustproof removable container containing:

(i)packets, containing hand cleanser and gauze cleansing pads;

(ii)adhesive dressings, individually wrapped;

(iii)compress dressings;

(iv)eye dressing kits;

(v)gauze dressings;

(vi)gauze bandages;

(vii)adhesive tape;

(viii)triangular bandages;

(ix)splint;

(x)one pair of scissors;

(xi)one pair of silver tweezers;

(xii)safety pins;

(xiii)manually operated suction apparatus with catheter; and

(xiv)Oropharyngeal airways in large, medium, and small sizes.

(17)The fire extinguisher, first aid kit, and axe or clawbar shall be mounted or secured in a location readily accessible to the driver and, if not in plain view, the location thereof shall be plainly marked.

(18)Be equipped with a means of securing in the open position, each passenger access door or emergency exit door that could be subject to unintentional closing during the loading or unloading of passengers.

(19)Be equipped with an interior mirror designed to provide the driver with a view of the passengers.

(20)Be equipped with lights arranged to illuminate all of the interior of the vehicle that shall be constantly lit during the loading or unloading of passengers.

(21)At least one door for passenger access and an emergency exit door located on different walls of the vehicle, and the emergency exit door shall be operable from both inside and outside the vehicle.

Multi-Purpose:

If a medical transportation vehicle is used for transporting a variety of clients with varying mobility needs (ambulatory clients, wheelchair clients, or stretcher clients) the vehicle must comply with the guidelines associated with each type of client.

Insurance:

The operator of the medical transportation service must carry adequate liability insurance.

The Emergency and Protective Services Committee submits the following report (January 20, 1999) from the Commissioner Works and Emergency Services:

Purpose:

The purpose of this report is to inform the Emergency and Protective Services Committee and Members of Council regarding the role and responsibility of Toronto Ambulance, as specified under the Ambulance Act of Ontario and its Regulations pertaining to the transportation of non-emergency patients within the City of Toronto.

Funding Sources, Financial Implications and Impact Statement:

There is no direct financial impact arising out of this report, however, future recommendations pertaining to licensing and regulation of private patient care transfer services and the enactment of the changes to the Ambulance Act Regulations may have a marginal impact on expenditures related to the delivery of out of hospital care and transportation within the City of Toronto.

Recommendation:

It is recommended that the following report be received for information by the Emergency and Protective Services Committee.

Background:

At its meeting on January 19, 1999, the Budget Committee received a deputation from the operator of Direct Care Patient Transfer Services. This firm is one of several unlicensed and unregulated private transfer providers operating within the City of Toronto. In his deputation to the Budget Committee, the deputant indicated the City of Toronto could save up to $14 million in the funding of its land ambulance service if the non-emergency transfers currently provided by Toronto Ambulance are brokered to private patient transfer services. This calculation was based on a formula of multiplying the 60,000 patient transfers currently provided through Toronto Ambulance by an average cost per call of $240.00.

The deputant further stated that the qualifications of the staff engaged in providing private patient transfer services are identical to the level of training of Toronto Ambulance paramedics and that all patient transfers currently provided by Toronto Ambulance could be safely moved by alternate means. The deputant concluded the shift of non-emergency transfers to private firms could free up ambulances for more important emergency calls and result in reduced expenditures on the cost of providing ambulance service within the City of Toronto.

Comments and/or Discussion and/or Justification:

Currently, Toronto Ambulance moves approximately 60,000 non-emergency patients on annual basis. Non-emergency transfers encompass movement of patients from institutions to institutions or specific medical treatment, homes to institutions for treatment and/or admission, and from institutions to home following discharge. Approximately 50,000 of the 60,0000 patients are transferred during the period Monday to Friday from 7 a.m. to 7 p.m. The balance of the transfers, approximately 20 percent or 10,000, are transferred during the weekend or at night.

Toronto Ambulance has organized its non-emergency transfer program to handle the bulk of the patient transfers on the Monday to Friday basis. Currently, there are approximately 40 staff engaged in this program operating between 10 and 12 ambulances per day. The total costs of providing non-emergency transfer program on a Monday to Friday basis is approximately $3.3 million, inclusive of salary, wages, vehicle costs and relating operating expenses. The balance of the non-emergency transfers, or approximately 10,000 per year, are handled out of the regular ambulance fleet and weekends and nights. These transfers are provided in the marginal surplus capacity that exists within the deployment plan. It would suggest that the overall costs, savings and/or expenditures related to providing non-emergency transfer services by Toronto Ambulance is $14 million and is not a correct calculation based on the manner in which Toronto Ambulance has organized its non-emergency patient transfer program.

Further, if the Ambulance Act and its Regulations permitted all transfers to be serviced by private transfer providers, the total savings to the City of Toronto and the ambulance services could be less than $3.3 million. This would only account for resources assigned to the non-emergency patient transfer program on a Monday to Friday basis. There would be no savings derived by eliminating transfers on weekends and nights as these transfers are carried by utilizing marginal surplus capacity within the emergency ambulance fleet.

Private fee-for-service transport companies raise an important public policy and social justice issue. The elderly, the ill and the disabled rely heavily on our non-emergency services, which are provided without user fees from the municipal tax base. Any transition to "user pay" services imposes a disproportionate burden upon those who can least afford it.

While the City itself might shed $3.3 million by ending its non-emergency ambulance services, we should be acutely aware that it would download that cost directly on those least able to afford it. If City policy creates a service accessible only to the wealthy, we would set a dangerous precedent in "two-tiered" health care, with a public system for the poor, and a private system for the well-to-do.

Similarly, contracting out this portion of our business, while paying for it from City taxes, would fail to make use of our paid-for infrastructure and introduce the cost of the private firm's profit as a new and avoidable cost.

The Ontario Ambulance Act and its Regulations, both current and proposed, place significant restrictions in the ambulance operator being able to delegate the responsibility of patient transfers in non-licensed ambulance services. The Act and its Regulations define a licensed ambulance service and this does not include private patient transfer services within its definition.

In addition, the proposed Regulations define the type of patient that can be transported by means other than a licensed ambulance service. Essentially, a patient that requires medical management, medical monitoring or has been determined by a medical practitioner to require medical supervision during transport, cannot be carried by a private patient transfer service. Patients who are eligible would only include patients who are otherwise healthy but because of some underlying physical restrictions, cannot be moved by wheelchair, vehicle, taxi and/or private car.

The Ambulance Act and its Regulations prohibit a licensed ambulance service from charging a non-emergency transfer services. The current rate for a private patient transfer service within the existing unregulated environment is approximately $65.00 to $80.00 per trip within the boundaries of the City of Toronto. These rates change depending on the distance travelled from the point of pick up. One of the issues to be reviewed as part of the process of regulating and licensing of these providers will be the establishment of a rate structure that is fair and equitable.

Of the total number of non-emergency patients transported by Toronto Ambulance between 10 percent and 20 percent could fall under the category of being eligible for transport by private transfer services. This figure is based on an assessment of calls completed by Toronto Ambulance in previous years.

Since 1995, the number of non-emergency transfers serviced by Toronto Ambulance has remained stable at approximately 60,000 per year. It is recognized that the number of non-emergency patients have increased over this period and it is believed that much of this increase has been distributed amongst the existing eight to ten private unregulated providers operating within the City.

The Ambulance Act and its accompanying Regulations, combined with the rules and guidelines governing the types of patients that can be transported by private service providers will not result in a significant change in the demand placed on Toronto's ambulance service. Marginal reductions of 10 percent to 20 percent in the overall volume currently serviced by Toronto Ambulance will be offset by expected increases in emergency demand on an annual basis. Projections by the Emergency of Health, Emergency Health Services Branch, supported by the Ernst & Young review of ambulance services in 1996, indicated a two percent increase in emergency demand compounded annually over the proceeding ten years. Any surplus capacity generated through reduction in non-emergency demand would be necessary to partially offset projected increase in emergency calls.

The proposed regulation and licensing of non-emergency private transfer providers by the Municipality will ensure that those patients deemed eligible by a medical practitioner would be guaranteed a safe and competent transportation and a fee structure approved by the Municipality. It should be recognized that even though the regulation and licensing of these providers could offer an alternative to the municipal ambulance service, the fact remains that restrictions on eligibility still exist through the Ambulance Act and its Regulations.

Conclusion:

It is the intent of this report to provide Members of Council with information concerning the regulations and standard that affect that transportation of patients within the City of Toronto. Medically essential transfers where there is a requirement for medical monitoring and medical supervision of patients will continue to be provided by Toronto Ambulance and only those patients who are deemed to be stable by a medical practitioner and/or designate could be transferred by a private alternative service provider.

Contact Name:

R.L. Kelusky

Tel: 397-9241/Fax: 392-2115

--------

The Emergency and Protective Services Committee reports, for the information of Council, also having had before it a communication (February 8, 1999) from Ms. Anne Dubas, President, Canadian Union of Local Employees, Local 79, respecting the Regulation and Licensing of Medical Transportation Services; and requesting CUPE Local 79 involvement in the proposed process to determine standards, in order to ensure that appropriate safe and accessible transport is available to all patients.

The following persons appeared before the Emergency and Protective Services Committee in connection with the foregoing matter:

-Mr. David Allen, Ambutrans;

-Mr. Harro Bauer, Paramedic, Toronto Ambulance; and

-Mr. Marc Bilz, Paramedic.

(City Council on March 2, 3 and 4, 1999, had before it, during consideration of the foregoing Clause, a communication (February 16, 1999) from Mr. Yochonan Buksbaum, President, Directcare Patient Transfer Inc.,submitting a proposal with respect to the transfer of non-emergency patients.)

3

Transfer of Surplus/Decommissioned Ambulances

to St. John Ambulance

(City Council on March 2, 3 and 4, 1999, adopted this Clause, without amendment.)

The Emergency and Protective Services Committee recommends the adoption of the following report (January 13, 1999) from the Commissioner of Works and Emergency Services:

Purpose:

The purpose of this report is to seek authorization to transfer a total four surplus/decommissioned ambulance vehicles to St. John Ambulance, Toronto Branch.

Funding Sources, Financial Implications and Impact Statement:

The financial implications associated with the transfer of four decommissioned ambulances to St. John Ambulance, Toronto Branch, would be the deferral of future revenues to be obtained through the sale of these vehicles at public auction. The estimated revenue impact would be approximately $6,000.00 based on a per unit value of $1,500.00 received through the sale of these vehicles at public auction.

Recommendations:

It is recommended that:

(1)City Council approve the transfer of four surplus/decommissioned ambulances to St. John Ambulance, Toronto Branch; and

(2)appropriate officials be given authority to give effect thereto.

 Council Reference/Background/History:

The City of Toronto and the former Metropolitan Toronto Council have supported St. John Ambulance, Toronto Branch, by providing an annual grant and through a relationship established with its ambulance service. Volunteers from St. John Ambulance, Toronto Branch, augment the City's professional emergency medical services system by providing first aid services during large public events and community activities as well as supporting the principle of public involvement through the many first aid and cardio pulmonary resuscitation training programs offered to the public. On an annual basis, St. John Ambulance, Toronto Branch, provides over 90,000 hours of first aid services to the community ensuring prompt and efficient first responder medical aid. These services are in part co-ordinated through Toronto Ambulance at events such as the Canadian National Exhibition, National Trade Centre events, Caribana, Molson Indy, street festivals and a wide-variety of local community events.

Comments and/or Discussion and/or Justification:

The transport division of St. John Ambulance, Toronto Branch, operates a number of mobile first aid posts. These vehicles are ambulances and while they are generally not utilized to transport patients, they are used to transport brigade volunteers to community events and to provide a base of operation for first aid staff at assigned locations. The demand on these vehicles is not considered to be excessive as compared to ambulances operated by the City of Toronto.

For the past three years, St. John Ambulance, Toronto Branch, has contracted Toronto Ambulance to maintain and repair its fleet of vehicles. The Fleet Operations Manager of Toronto Ambulance advised that a number of vehicles currently utilized by St. John Ambulance, Toronto Branch, had reached the end of their functional life span and could not be certified, as safe, under the provisions of the Highway Traffic Act of Ontario. Many of the vehicles had been purchased in the early 1980s and the amount of money required to ensure their continued safe operation would far exceed the value of the vehicle.

As St. John Ambulance is a volunteer agency reliant on donations and grants, the capital costs associated with replacing its vehicles at this time would be significant. In an effort to assist St. John Ambulance and to enable them to continue to provide their valuable community service, Toronto Ambulance is seeking approval to transfer up to four of its surplus/decommissioned ambulances to the Toronto Branch. These vehicles have reached the end of their functional life span as a 24-hour operating vehicle, however, they are in sufficient mechanical condition to operate as a mobile first aid post for St. John Ambulance. Toronto Ambulance would ensure that these vehicles are mechanical fit and certified in accordance with the Highway Traffic Act of Ontario. Following the transfer of the vehicles, Toronto Ambulance will be seeking permission from St. John Ambulance, Toronto Branch, to clearly note on the side of the vehicles that they were donated by the City of Toronto. St. John Ambulance will assume responsibility for all future maintenance and repair costs for these vehicles.

Conclusion:

The ability of St. John Ambulance to continue to provide community first aid services to the City of Toronto will ensure the availability of on-site first aid response for those events generally not serviced by Toronto Ambulance. Continuing to support this agency through both the annual financial grant and through the transfer of surplus assets, such as ambulance vehicles, supports the principle of promoting safety within the City of Toronto. The deferral of approximately $6,000.00 in revenues that would normally have been received through public auction would not pose any financial hardship on the Ambulance Division.

Contact Name:

Ron Kelusky

Tel: 392-2200/Fax: 392-2115

4

Schedule of Taxicab Inspections

(City Council on March 2, 3 and 4, 1999, adopted Recommendation No. (1) of the Emergency and Protective Services Committee; and amended this Clause by striking out the following portion of the recommendation embodied in the report dated January 26, 1999, from the Commissioner of Urban Planning and Development Services:

"and that the complete schedule of taxicab inspections be made available upon request at a cost of $30.00 per inspection schedule".)

The Emergency and Protective Services Committee:

(1)recommends the adoption of that portion of the recommendation of the Commissioner of Urban Planning and Development Services contained in the following report dated January 26, 1999, viz:

"That Toronto Licensing continue to notify taxicab owners only of the time and date of the scheduled vehicle inspections, and that requests for rescheduling be discussed only with the taxicab owner."; and

(2)submits without recommendation that portion of the recommendation of the Commissioner of Urban Planning and Development Services, viz:

"and that the complete schedule of taxicab inspections be made available upon request at a cost of $30.00 per inspection schedule.":

Purpose:

At its meeting of November 3, 1998, the Emergency and Protective Services Committee had for its consideration communications from Mr. Gene MacDonald and Mr. Stan Steiner regarding the schedule of inspections for taxicabs. The Committee referred this matter to the Commissioner of Urban Planning and Development Services for a report thereon to Committee.

Funding Sources, Financial Implications and Impact Statement:

There are no financial impacts; the $30.00 fee covers the cost of photocopying the schedule.

Recommendation:

That Toronto Licensing continue to notify taxicab owners only of the time and date of the scheduled vehicle inspections; that requests for rescheduling be discussed only with the taxicab owner and that the complete schedule of taxicab inspections be made available upon request at a cost of $30.00 per inspection schedule.

Background:

As an initiative to cause taxicab owners to be more involved with the operation of their taxicab, in June 1997, the Metropolitan Licensing Commission decided that the information regarding scheduled vehicle inspections would be provided to taxicab owners only. Prior to this decision interested parties were able to purchase a complete schedule of taxicab inspections, times and dates. In September 1997, the Metropolitan Licensing Commission was then approached to permit taxicab owners to use their designated agent's address rather than their own address, and again the Commission restated their concern that the taxicab owner be directly involved with the operation of their vehicle including the mechanical inspection and the Commission refused the industry request. Subsequent to these decisions there were several requests for the complete schedule of inspections, including a request from Mr. Gene MacDonald of Cab Connection. Cab Connection had been publishing a full schedule of inspection times and dates. All requests for the schedule were refused.

In October 1998, Mr. MacDonald made a formal Freedom of Information request for the schedule information. This request was rejected and to date we have not been advised on an appeal of this decision. Until suitable by-law changes are implemented, the Licensing Commission is a separate institution for Freedom of Information purposes.

The City Council decision of May 13 and 14, 1998, regarding the restructuring of the Licensing Commission stated:

"(11)the implementation of the restructuring with respect to policy matters and adjudicative functions be phased-in as follows:

(a)effective immediately, all new licensing policy issues be forwarded to the Emergency and Protective Services Committee for consideration; and

(b)the current Licensing Commission continue to consider matters pertaining to the taxi industry until the recommendations of the Task Force for Reform of the Taxi Industry are considered by Council, after which such policy issues will be considered by the Emergency and Protective Services Committee."

The final report of the Task Force was adopted by Council on November 25, 26 and 27, 1998.

Recommendation (14)(d) of the approved Task Force to Review the Taxi Industry report states:

"(14)(d)all Standard Licence owners must participate in the industry by:

-personally attending all three annually scheduled inspections;

-file annual documents in person at Toronto Licensing; and

-attend all hearings relating to that owner's license or vehicle in person.

This recommendation reinforces the Commission's concern that taxicab owners maintain control over the operation of their taxicabs. However, the Taxicab Task Force report not only requires that the taxicab owner personally attend each mechanical inspection and file all documents in person they must also participate in an annual refresher course that will emphasize the need to be conscientious regarding all of their responsibilities under the By-law. The Committee may consider that the combination of these conditions will have sufficient impact to effect the desired participation by the taxicab owner so that the restriction on the availability of the schedule could be rescinded.

Toronto Licensing will continue to use the industry publications and the various licensing mailings to advise owners and drivers of the implementation of the Task Force recommendations and of changes to the Licensing By-laws.

Contact Name and Telephone Number:

Carol Ruddell-Foster,

General Manager, Toronto Licensing

Tel: 392-3070

--------

The following persons appeared before the Emergency and Protective Services Committee in connection with the foregoing matter:

-Mr. Jim Bell, Diamond Taxi;

-Mr. Ian Allaby;

-Mr. Gene MacDonald, Publisher, and Mr. Stan Steiner, Cab Connection; and submitted a brief in regard thereto;

-Mr. Robert A. Stewart; and

-Mr. Eugene Meikle.

5

Amendments to Toronto Licensing By-law No. 127 -

Driving School Prohibited Area

(City Council on March 2, 3 and 4, 1999, struck out and referred this Clause back to the Emergency and Protective Services Committee for further consideration.)

The Emergency and Protective Services Committee recommends that the provisions of Toronto Licensing By-law No. 127 be incorporated into Licensing By-law No. 20-85 of the former Municipality of Metropolitan Toronto, together with the proposed amendments regarding driving school prohibited areas contained in the following report (January 22, 1999) from the Commissioner of Urban Planning and Development Services:

Purpose:

The purpose of this report is to outline changes respecting the Ministry of Transportation Driver Examination Test Routes affecting the Toronto Licensing By-law No. 127.

Funding Sources, Financial Implications and Impact Statement:

There are no financial implications with this report.

Recommendation:

In order to accommodate the extended test routes, which go beyond the Don Valley Parkway, on the west boundary, it is recommended that the prohibited area for North York/Scarborough, presently incorporated into the Toronto Licensing By-law No. 127, be amended to:

(1)(ii)North York/Scarborough:

(a)The area bounded on the north by Highway 401, on the west by Leslie Street, on the east by Warden Avenue and the Ashtonbee CPR spur line and on the south by Eglinton Avenue East.

Authority:

Subsection 4 of Section 6 of Schedule 12 to By-law No. 20-85 gives authority to the Commission to designate by by-law any streets or areas in the Toronto area as the Commission may wish to prohibit or restrict driving instructors from giving instructions upon such streets or areas.

Background:

After almost 20 years at the 773 Warden Avenue location, the Ministry of Transportation's Metro East Examination Centre relocated on August 2, 1991, to 1448 Lawrence Avenue East. This current location is in a commercial plaza located at the north-west corner of Victoria Park Avenue and Lawrence Avenue East.

The Commission enacted and passed By-law No. 114 on July 11, 1991, to accommodate the 1991 relocation. By-law No. 114, being a by-law respecting the prohibition of driving instruction on certain streets and in current areas in The Municipality of Metropolitan Toronto, was subsequently repealed and the Commission enacted and passed the current By-law No. 127 on February 20, 1997, which added a prohibited area in the north-west area of Toronto, referred to as the "North York" area.

Ministry staff have always expressed a strong need to maintain a prohibited area surrounding any test facility. The existence of a Prohibited Area allows Ministry staff to maintain the sensitive balance between the host neighbourhood and the need to road-test license applicants prior to the issuance of a driver's licence. A prohibited area benefits the residents by precluding the normal influx of driving school vehicles, yet serves the needs of the Ministry, respecting its need to road-test students in an area unfamiliar to them.

Existing North York/Scarborough Prohibited Area:

-on the south by Eglinton Avenue East;

-on the east by Warden Avenue and the Ashtonbee CPR Spur line;

-on the north by Highway 401; and

-on the west by Don Valley Parkway.

New Developments\Extended Test Routes:

Ministry of Transportation staff have advised that they are now using the following streets west of the Don Valley Parkway as part of their Driver Examination Test Routes:

Overton Crescent, Belton Road, Duncairn Road, Langbourne Place, Jocelyn Crescent, The Donway West, The Donway East, Broadleaf Road, Larkspar Lane and Briarfield Drive.

Conclusion:

In order to accommodate the changes to the Ministry's test routes, it is therefore recommended that the amendment to change the west boundary, from the Don Valley Parkway to Leslie Street, be adopted.

Contact Name and Telephone Number:

Carol Ruddell-Foster,

General Manager, Toronto Licensing

Tel: 392-3070

(A copy of each of the Metropolitan Licensing Commission By-law No. 127 and communication (October 30, 1998) from the Ministry of Transportation attaching a map highlighting the streets to be added to its current boundaries was forwarded to all Members of Council with the agenda of the Emergency and Protective Services Committee for its meeting on February 9, 1999, and a copy thereof is on file in the office of the City Clerk.)

The Emergency and Protective Services Committee reports, for the information of Council, also having had before it during consideration of the foregoing matter communications from the following:

-(February 5, 1999) from Mr. Joey L.P. Singh in opposition to the amendment, and requesting a deferral in order to allow time to prepare a proper deputation;

-(February 5, 1999) from Mr. Amir Kanji requesting that consideration of the proposed amendment to the By-law be deferred to allow time to research the implications;

-(February 6, 1999) from Mr. Hugh Peart, President, Independent Driver Educators Association, advising that the Association on February 6, 1999, held a special meeting to discuss the proposed amendments to By-law No. 127; and requesting that the Committee defer consideration of the proposed amendments to provide the respondent with reasonable time to prepare its deputation on behalf of members of the Association; and

-(February 9, 1999) from Councillor Gordon Chong, Don Parkway, requesting that the spelling of a number of the streets listed under "New Development/Extended Test Routes" be corrected.

(City Council on March 2, 3 and 4, 1999, had before it, during consideration of the foregoing Clause, a communication (February 20, 1999) from Mr. Hugh Peart, President, Independent Driver Educators Association (I.D.E.A.), requesting that disclosures with respect to the proposed amendments to Toronto Licensing By-law No. 127 - Driving School Prohibited Area be forwarded to I.D.E.A.)

6

Collision Reporting Centres -

Legal Proceeding Commenced by

Allstate Insurance Company of Canada, et al.

(City Council on March 2, 3 and 4, 1999, amended this Clause, by striking out the recommendation of the Emergency and Protective Services Committee and inserting in lieu thereof the following:

"It is recommended that:

(1)the following recommendation embodied in the confidential report dated February 2, 1999, from the City Solicitor, be adopted, the balance of such report to remain confidential in accordance with the provisions of the Municipal Act:

'(1)if City Council decides to oppose the Court Application commenced by Allstate Insurance Company of Canada, et al, Anne Kendall of the law firm of Borden & Elliott be retained as counsel for the City in this matter;' and

(2)the City Solicitor be requested to submit the report previously requested on the possibility of establishing a fourth Collision Reporting Centre operated by the City of Toronto, to the next meeting of the Emergency and Protective Services Committee, and the Committee be requested to submit its recommendations with respect thereto to the next regular meeting of City Council to be held on April 13, 1999.")

The Emergency and Protective Services Committee recommends that the confidential report (February 2, 1999) from the City Solicitor, entitled "Collision Reporting Centres and the Legal Proceeding Commenced by Allstate Insurance Company of Canada, et al., which was forwarded to all Members of Council under confidential cover, be received.

(City Council on March 2, 3 and 4, 1999, had before it, during consideration of the foregoing Clause, a confidential report (February 2, 1999) from the City Solicitor, such report to remain confidential in accordance with the provisions of the Municipal Act, save and except the recommendations embodied therein:

(Extract from the confidential report dated February 2, 1999,

from the City Solicitor.)

Recommendations:

It is recommended that:

(1)if City Council decides to oppose the Court Application commenced by Allstate Insurance Company of Canada, et al, Anne Kendall of the law firm of Borden and Elliott be retained as counsel for the City in this matter;

(2)if City Council decides not to oppose the Court Application commenced by Allstate Insurance Company of Canada, et al, subsection 14(2) and section 15 of Part 6 to Schedule 24 of By-law No. 20-85 of the former Metropolitan Council be amended such that these provisions do not apply to insurance companies and their representatives and employees; and

(3)the provincial legislature, through the Financial Services Commission of Ontario, be requested to amend the Insurance Act by enacting provisions with the same effect as subsection 14(2) and section 15 of Part 6 to Schedule 24 of By-law No. 20-85.)

7

Rationalization of Six Existing Committees

and the Task Force on Community Safety.

(City Council on March 2, 3 and 4, 1999, amended this Clause by:

(1)striking out Recommendation No. (3) embodied in the joint report dated January 26, 1999, from Councillor Rob Davis and Councillor Brad Duguid, Co-Chairs of the Task Force on Community Safety, as amended by the Emergency and Protective Services Committee; and

(2)adding thereto the following:

"It is further recommended that:

(a)TaxiWatch (formerly Taxis on Patrol) continue to receive Secretariat support from the City Clerk's Division;

(b)Council show its support for the TaxiWatch program by considering its annual grant from the City; and

(c)the following recommendation be referred to the Etobicoke Community Council for consideration:

'It is recommended that the functions of the Etobicoke Safety Council, the Etobicoke Crime Scope and the Toronto (formerly Etobicoke) Crime Prevention Association be transferred to the City's Cycling and Pedestrian Committees to promote traffic safety issues in the City of Toronto.' ")

The Emergency and Protective Services Committee recommends the adoption of the following report (January 26, 1999) from Councillor Rob Davis and Councillor Brad Duguid, Co-Chairs of the Task Force on Community Safety, subject to amending Recommendation No. (3) to read as follows:

"(3)the functions of the Etobicoke and East York Safety Councils be transferred to the Cycling and Pedestrian Committees to promote traffic safety issues in the City of Toronto;":

Purpose:

This report responds to the request for the Task Force on Community Safety to review the financial implications of continuing several committees and to discuss the rationalizations of these committees based on the work undertaken by the Task Force. It is intended as a companion piece to the Final Report of the Task Force on Community Safety.

Recommendations:

It is recommended that:

(1)TaxiWatch (formerly Taxis on Patrol) continue to receive staff support for its work in organizing taxi drivers to report suspicious activities to the police and other authorities;

(2)the Emergency Planning Unit (formerly the Emergency Planning Advisory Committee) continue as a staff committee;

(3)members of the Etobicoke and East York Safety Councils be encouraged to work with the Cycling and Pedestrian Committees to promote traffic safety issues in the City of Toronto;

(4)members of the Safe City Committee and Etobicoke Crime Scope be encouraged to work with existing City-funded initiatives to promote community safety, including Crime Concern, METRAC (the Metro Action Committee on Violence Against Women and Children) and any new initiatives that arise from the adoption of the Final Report of the Task Force on Community Safety.

Council Reference:

At the first meeting of Emergency and Protective Services for the new City of Toronto on January 13, 1998, Councillor Layton identified six committees that should "be encouraged to meet and carry on their important work, pending the outcome and implementation of Council's review of the Transition Team report". These six committees are:

East York Safety Council;

Emergency Planning Advisory Committee (of the former Metropolitan Toronto government);

Etobicoke Crime Scope;

Safe City Committee (of the former City of Toronto government);

Safety Council (of the former Etobicoke government); and

Taxis on Patrol Committee (of the former Metropolitan Toronto government).

In a report dated January 27, 1998, the Acting Commissioner of Works and Emergency Services recommended that "when the terms of reference for the new Task Force on Community Safety have been prepared, [that] they be sent to the six existing committees, together with a copy of this report, and that each of the six committees be asked to comment on the ongoing need for their work, if any, on their relationship to the Task Force, and on their ongoing staff needs."

This recommendation was adopted by the Emergency and Protective Services Committee at its meeting of February 10, 1998, which further requested the Task Force on Community Safety to "review the financial implications of continuing" these committees.

In a report dated March 23, 1998, the Task Force responded to the Emergency and Protective Services Committee that it would respond to these questions as part of the final report of the Task Force on Community Safety, in January of 1999.

Also, at its meeting of April 3, 1998, the Special Committee to Review the Final Report of the Toronto Transition Team requested the Task Force on Community Safety to "identify other community-based organizations that provide similar activities as those to be undertaken by the Task Force with a view to co-ordinating all activities related to community safety."

Comments:

There are two important points to note at the onset:

(1)the six committees noted in the original communication deal with very different safety issues; and

(2)these six committees are very different in terms of structure and support from local government.

A brief description of each of these six committees, in terms of mandate, structure, support from local government, status, and financial implications of continuing these committees is as follows:

East York Safety Council:

The East York Safety Council has been in existence since 1967. It was a volunteer advisory committee to the former East York Council. It dealt with injury prevention issues such as children's safety in going to and from school, bike safety, and traffic safety, especially for seniors. It has not involved itself in crime prevention issues. It did receive secretarial support for minute taking and mailing from the former Borough of East York, with total staff hours estimated as 250 per year in February of this year. It has not had quorum for a meeting in several months.

Emergency Planning Unit (formerly the Emergency Planning Advisory Committee):

Emergency Planning Advisory Committee was a staff committee of the former Metropolitan Toronto government, which continues to meet in the new City of Toronto. It consists of staff from the Fire Service, Sanitation, Ambulance Services, Transportation, and Hydro, who meet on an ad hoc basis to develop plans so that the City can respond to catastrophic events such as an ice storm or major flood. It does not deal with crime prevention issues, and its scope is well beyond the purview of the Task Force on Community Safety.

Etobicoke Crime Scope:

Etobicoke Crime Scope consists of volunteers from the Etobicoke community, with a part-time paid staff person supported by federal and provincial grants. They receive in-kind support from the Parks and Recreation Division, in the form of an office at Etobicoke Civic Centre, the use of office equipment (computer, phone, fax), and approximately 100 hours a year of assistance from City staff.

The organization works on crime prevention issues, especially those issues arising from recommendations contained in the Final Report of the Etobicoke Mayor's Task Force on Community Safety (1996). There are four sub-committees: Youth Issues, Police Issues, Community Standards, and Community Harmonization.

Crime Scope did apply for a small grant from the City of Toronto in 1998. It was requested to work with the Etobicoke Crime Prevention Association (now the Toronto Crime Prevention Association) to co-ordinate crime prevention work in the Etobicoke area. To this date, this co-ordination has not occurred, and the two organizations continue to work at cross purposes. For instance, Crime Scope worked on a "Neighbours Night Out" event on June 16, 1998, while the Etobicoke Crime Prevention Association held a completely separate "National Night Out" event on August 4, 1998.

There are some concerns about the ongoing viability of this organization, since its contracts with senior levels of government have ended. The Youth Issues Sub-Committee, which has not met for several months, might be a good fit with the Youth Council for the Children and Youth Action Committee.

 Safe City Committee:

The Safe City Committee consisted of representatives from community organizations and members of City Council for the former City of Toronto. The Committee was created in 1989 to monitor the implementation of the Safe City Report (1988) and to develop further policy aimed at the prevention of violence. The Committee reported to Toronto City Council.

The Safe City Committee does not at present receive any staff or financial support from the new City of Toronto, and has not met since the beginning of 1998. Several former members of the Safe City Committee sit on the Task Force on Community Safety.

Etobicoke Safety Council:

The Etobicoke Safety Council has been in existence since 1967. It deals with bicycle safety, car safety, fire safety, and injury prevention education in schools and in the community. While it was a member of the Etobicoke Mayor's Task Force on Community Safety, it does not focus on crime prevention.

The Council received a grant of $3,650.00 in 1998 from the City of Toronto, and approximately 72 hours a year of clerical support from City staff for meetings and mailings. The Council continues to meet.

TaxiWatch:

TaxiWatch, as the former Taxis on Patrol Committee is presently known, was created by the former Metropolitan Council in 1983 to support the taxi industry's contribution to community safety. It supports taxi drivers in their attempts to report and, in some cases, personally assist where individuals are at risk or in need of help from emergency response units. The Committee distributes decals which identify the taxi as part of this volunteer program and arranges an annual award ceremony. TaxiWatch meets approximately five times per year. The City of Toronto provides a part-time co-ordinator through the Urban Planning and Development Services Department, Municipal Licensing and Standards Division. In structure and support, it is similar to the Transit Community Watch program run by the Toronto Transit Commission.

Other Community Safety-related Committees Supported by the City of Toronto.

There are many neighbourhood and community-based committees that address safety concerns which receive staff support. For instance, the Park Watch program in High Park receives staff support from the Parks and Recreation Division, Public Health staff work with the Partners in Prevention project in North York, and Social Development staff assisted in the Lakeshore Community Audit which included some community safety indicators work.

The City of Toronto also supports hundreds of community organizations that address community safety concerns through its grants programs, including Breaking the Cycle of Violence, Drug Abuse Prevention, Recreation and Access and Equity. Several of these organizations were created by former municipalities, such as the Woman Abuse Council, the Child Abuse Centre, and the Metro Action Committee on Public Violence Against Women and Children, which all developed out of Task Forces in the former Metropolitan Toronto during the 1980s. Crime Concern developed out of a task force in the former City of North York in the 1980s, and continues to be funded by the City of Toronto.

There are, however, no City-wide committees that overlap with the Task Force on Community Safety's mandate, which is to "develop a comprehensive and co-ordinated plan for the City of Toronto that will make our City a world leader in community-based crime prevention." Now that the Task Force has accomplished its mandate, there are no citizen advisory committees that exist on a City-wide basis to monitor the implementation of the Task Force's recommendations, or develop further policy aimed at promoting community safety or preventing crime.

Future of These Committees:

The January 27, 1998, report from the Acting Commissioner of Works and Emergency Services asked:

(1)Does the new City need all six of above committees as well as its Task Force?

(2)Does the new City have the staff resources to continue supporting both the committees and the Task Force?

As can be seen from the descriptions above, these six committees deal with very different "safety issues".

The East York and Etobicoke Safety Councils address an "injury prevention" model of "safety", which stresses traffic safety and educating young children on being safe cyclists and pedestrians. The Emergency Planning Advisory Committee develops corporate responses to catastrophic events, such as ice storms and major floods. TaxiWatch supports taxi drivers in their attempts to report, and in some cases, personally assist where individuals are at risk or in need of help from emergency response units. Etobicoke Crime Scope and the Toronto Safe City Committee focus on community safety and crime prevention. Only three of the six committees discussed deal directly or indirectly with crime prevention (Etobicoke Crime Scope, the Toronto Safe City Committee, and, to a lesser extent, TaxiWatch). This was noted in the January 27, 1998, report from the Acting Commissioner of Works and Emergency Services, which noted that the new Task Force on Community Safety's "areas of overlap... appear to be minimal except for Toronto's Safe City Committee and Etobicoke's Crime Scope."

At the same time, a certain natural "sorting out" of committees has occurred in the past year. The Safe City Committee and the East York Safety Council have not met for several months. Etobicoke Crime Scope has been requested by the Municipal Grants Review Committee to work with the Etobicoke Crime Prevention Association.

There are new avenues of involvement on safety-related issues. In the new City of Toronto, there is at present a Pedestrian Committee which advises Public Works and Environment on traffic safety issues. There is also a Cycling Committee which is very active in bicycle safety issues. It is suggested that members of the East York and Etobicoke Safety Councils work with these groups to promote pedestrian and bicycle safety.

The staff resources necessary to continue TaxiWatch and Emergency Planning Unit are minimal, and these two initiatives would seem to provide good "value for money", although neither has undergone a formal evaluation for effectiveness. The Emergency Planning Unit is clearly a core initiative for the City of Toronto.

Conclusions:

None of the six groups identified are special committees, reporting to City Council through a standing committee. Only two of the six groups identified deal with community safety and crime prevention issues covered by the Task Force on Community Safety. Of these two groups, only one is still meeting, and the future of this group is in doubt, based on lack of funding.

With the exception of the Emergency Planning Unit, which is an internal staff group with no special committee status or funding needs beyond staff time, all of the groups mentioned have very modest costs to the City of Toronto.

The Etobicoke and East York Safety Committees should work with Pedestrian and Cycling Committees on traffic safety issues. The Youth Issues Sub-Committee of Etobicoke Crime Scope should work with the Children and Youth Action Committee on issues of concern to youth.

--------

The Emergency and Protective Services Committee reports, for the information of Council, also having had before it during consideration of the foregoing matter a communication (February 9, 1999) from Ms. Connie Micallef, Chair, Crime S.C.O.P.E., Etobicoke, commenting on a number of issues and clarifying a few incorrect statements referred to in the report of the Task Force on Community Safety.

(City Council on March 2, 3 and 4, 1999, had before it, during consideration of the foregoing Clause, the following communications in support of maintaining the Etobicoke District Safety Council:

(i)(February 26, 1999) from the District Chief, West Command, Etobicoke Division, Toronto Fire Services;

(ii)(March 1, 1999) from Sgt. Theo Holtzheuser, 22 Traffic Response Unit, Toronto Police Service; and

(iii)(March 1, 1999) from Mr. Jeffrey Zajac, Chair, Etobicoke Safety Council.)

8

Other Items Considered by the Committee

(City Council on March 2, 3 and 4, 1999, received this Clause, for information.)

(a)Amendment to Schedule 24 of By-law No. 20-85 - Body Shops/Automobile Service Centres - Regulation of Hours of Operation.

The Emergency and Protective Services Committee reports having:

(1)deferred consideration of the following reports from the City Solicitor and Commissioner of Urban Planning and Development Services;

(2)referred the matter of regulation of hours of operation for body shops/automobile service centres to the Commissioner of Urban Planning and Development Services with a request that she canvass Members of Council to identify and review specific problems that Councillors may have to see if there are alternative solutions to address such problems, and report thereon to the Emergency and Protective Services Committee in two months' time; and

(3)directed that the City Solicitor and Commissioner of Urban Planning and Development Services be requested to report to the Emergency and Protective Services Committee on the necessity of harmonizing the definition relating to "public garages" in By-law No. 20-85, and "automobile service stations" and related definitions, including gas bars, etc., in the various zoning by-laws, so that it is clear that all retail gasoline outlets are subject to the proposed by-law:

(i)(January 22, 1999) from the Commissioner of Urban Planning and Development Services recommending that:

(1)the report of the City Solicitor, entitled "Body Shops/Automobile Service Centres - Regulation of Hours of Operation/Ventilation," be amended to increase the prohibited area in which body shops/auto service centres cannot locate to within 122 metres of a residential zone; and

(2)East York By-law No. 112-92 be rescinded;

(ii)(November 25, 1998) from the City Solicitor recommending that:

(1)should the Committee wish to recommend that the hours of operation of public garages used as car washes, motor vehicle repair shops and automobile service stations located within a residential zone or within 100 metres of a residential zone be restricted to prohibit their operation except between the hours of 7:00 a.m. and 9:00 p.m. (Monday to Friday) and 9:00 a.m. to 6:00 p.m. (Saturday and Sunday), the City Solicitor be authorized to prepare and introduce in Council an amendment in substantially the form attached to this report to amend Schedule 24 of Licensing By-law No. 20-85;

(2)the Commissioner of Urban Planning and Development Services be requested to prepare a report to the Emergency and Protective Services Committee concerning the impact of these amendments on Chapter 199 of the City of Toronto Municipal Code and East York By-law No. 112-92, which impose early closing hours on gasoline outlets also potentially affected by the amendments proposed in this report, to be considered at the next meeting of the Committee;

(3)prior to the introduction of any bills in Council, this matter be scheduled for public deputations before the Emergency and Protective Services Committee at its meeting with appropriate notice of the meeting to be advertised and given to affected licensees; and

(4)the General Manager of Toronto Licensing be directed to provide a 60-day "grace period" prior to enforcing any by-law which may be passed by Council against affected licensees;

(iii)(December 29, 1998) from Mr. Bill Davis, Director, Government Relations, The Ontario and Toronto Automobile Dealers' Association, requesting the opportunity to address the Emergency and Protective Services Committee on restricting the hours of operation of the auto repair service centres and body shops; and

(iv)(January 18, 1999) from Mr. John Norris, spokesperson, Collision Industry Action Group, on behalf of the Toronto Collision Repair Society, requesting the opportunity to appear before the Emergency and Protective Services Committee on restricting the hours of operation of the auto repair service centres and body shops.

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The following persons appeared before the Emergency and Protective Services Committee in connection with foregoing matter:

-Mr. Bill Davis, Director, Government Relations, The Ontario and Toronto Automobile Dealers' Association;

-Mr. John Norris, on behalf of the Toronto Collision Repair Society;

-Ms. Victoria Masnyk, Swansea Area Ratepayers Association, and submitted a brief in regard thereto;

-Mr. Paul Smith, Manager of Real Estate and Development, Shell Canada Products Limited;

-Mr. Bob Clapp, Vice-President, Canadian Petroleum Products Institute;

-Mr. Mike Wines, Independent Auto Repairer's Association, and submitted a brief in regard thereto;

-Ms. Ziona Cowen;

-Mr. Bob Liptrott, Real Estate Manager, Sunoco Inc.;

-Mr. Jack Irwin, Petro Canada;

-Mr. Arv Sestokas, Imperial Oil;

-Mr. Ron Braun, President, Ripley Area Residents Group, and submitted a brief in regard thereto; and

-Mr. Andy Reti, The Toronto Taxicab Owners and Operators Association, and submitted a brief in regard thereto.

(b)Ministry of Health, Emergency Health Services and Toronto Based Hospital - Mandatory Training for Paramedics.

The Emergency and Protective Services Committee reports having received the following report; and having directed that a copy be forwarded to the Budget Committee for its information:

(January 18, 1999) from the Commissioner of Works and Emergency Services advising that the Ministry of Health, Emergency Health Services Branch requires ambulance operators to provide annual mandatory training, certification maintenance and continuing medical education programs to all paramedic staff; noting that funds for these programs must be identified within the existing Toronto Ambulance budget, and any decreases in available funding may impact the ability to meet these requirements; and recommending that the report be received for information.

(c)Toronto Police Service - Human Resource Strategy for the Years 1999-2003.

The Emergency and Protective Services Committee reports having received the following communication; and having directed that it be forwarded to the Budget Committee for consideration during the 1999 Operating Budget:

(January 6, 1999) from the Chairman, Toronto Police Services Board, advising that the Toronto Police Services Board on December 15, 1998, had before it a report (November 30, 1998) from the Chief of Police respecting the Toronto Police Service's Human Resource Strategy, 1999-2003; outlining the actions of the Board in regard thereto; and recommending that the Emergency and Protective Services Committee receive the report for information and forward it to the next meeting of Council for information during consideration of the Toronto Police Service's 1999 Operating Budget.

(d)Proposed Combining of Toronto Police Service's Divisions 12 and 13.

The Emergency and Protective Services Committee reports having referred the following communication to the Chairman of the Toronto Police Services Board with a request that he report thereon to the Emergency and Protective Services Committee on all proposed Police Division amalgamations and proposed boundaries:

(December 10, 1998) from the Councillor Joe Mihevc, York-Eglinton, advising of his opposition to the proposed amalgamation of the Toronto Police Service's Divisions 12 and 13.

(e)Fire and Ambulance Response to Snow Emergency.

The Emergency and Protective Services Committee reports having received the following reports:

(i)(January 26, 1999) from the Commissioner of Works and Emergency responding to the request of the Emergency and Protective Services Committee to report on the impact and response of Toronto Ambulance to the snow storm on January 3 and 4, 1999; and recommending that the report be received for information; and

(2)(January 27, 1999) from the Commissioner of Works and Emergency Services responding to the request of the Emergency and Protective Services Committee to report on the impact and response of Fire Services to the recent snowstorms and cold weather emergency; and recommending that the report be received for information.

Respectfully submitted,

DENNIS FOTINOS

Chair

Toronto, February 9, 1999

(Report No. 2 of The Emergency and Protective Services Committee, including additions thereto, was adopted, as amended, by City Council on March 2, 3 and 4, 1999.)