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Decision Document |
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Board of Health |
Meeting No. | 25 | Contact | Candy Davidovits, Committee Administrator | |
Meeting Date |
Monday, October 19, 2009 |
Phone | 416-392-8032 | |
Start Time |
1:00 PM |
boh@toronto.ca | ||
Location |
Committee Room 1, City Hall
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Chair | Councillor John Filion |
The Decision Document is for preliminary reference purposes only. Please refer to the Board of Health’s Report to City Council or to the Minutes for the official record.
How to Read the Decision Document: • Recommendations of the Board of Health to City Council appear after the item heading under the heading "Committee Recommendations". • Other action taken by the Board on its own authority, which does not require Council’s approval, is listed in the decision document under the heading “Committee Decision”. • Declarations of Interest, if any, appear at the end of an item.
Minutes Confirmed – June 15, 2009
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HL25.1 | Presentation |
Received |
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Ward: All |
2009 Public Health Champion Awards |
Committee Decision |
The Board of Health:
1. received, for information, the presentation by the Co-Chairs, Public Health Champion Awards Selection Committee; and
2. congratulated the recipients of the 2009 Public Health Champion Awards:
- Lillie Johnson, Canadian Sickle Cell Society, in the individual category; and - Community Matters Toronto in the group/organization category; and
3. directed that the documents submitted on behalf of the nominees remain confidential as they contain personal information about identifiable individuals, including City or local board employees. |
Decision Advice and Other Information |
Vaijayanthi Chari and Valerie Sterling, Co-Chairs of the Public Health Champion Awards Selection Committee, announced that the recipients of the 2009 Public Health Champion Awards will be:
- Lillie Johnson, Canadian Sickle Cell Society, in the individual category; and - Community Matters Toronto in the group/organization category. |
Summary |
The Co-Chairs of the Public Health Champion Awards Selection Committee to announce the recipients of the 2009 Public Health Champion Awards. |
Background Information |
hl25.1 - Letter from the Public Health Champion Awards Selection Committee (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24267.pdf) |
Communications |
(October 19, 2009) Submission from Toronto Public Health (HL.New.hl25.1.1) |
HL25.2 | Information |
Amended |
|
Ward: All |
Pandemic Influenza Preparedness Update |
Committee Decision |
The Board of Health:
1. received, for information, the update on pandemic influenza preparedness; and
2. referred the submission from Beric German and Anne Egger, Toronto Pandemic Homeless Working Group, together with the submissions from other speakers, to the General Manager, Shelter, Support and Housing Administration, in consultation with the Medical Officer of Health, for consideration in any future reports and other appropriate action. |
Decision Advice and Other Information |
Dr. Barbara Yaffe, Director and Associate Medical Officer of Health, and Dr. David McKeown, Medical Officer of Health, gave an update on the pandemic influenza preparedness. |
Summary |
The Medical Officer of Health will give a verbal update on Pandemic Influenza Preparedness. |
Communications |
(October 19, 2009) Submission from Toronto Disaster Relief Committee (HL.New.hl25.2.1) (October 19, 2009) Submission from Beric German and Anne Egger, Toronto Pandemic Homeless Working Group (HL.New.hl25.2.2) (October 19, 2009) Submission from Lynn Anne Mulrooney (HL.New.hl25.2.3) (October 19, 2009) Submission from Linsey MacPhee (HL.New.hl25.2.4) |
HL25.3 | ACTION |
Amended |
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Ward: All |
Influenza Immunization Rates of Healthcare Workers in Toronto Healthcare Facilities |
Committee Decision |
The Board of Health directed that:
1. The CEOs of acute care hospitals, complex continuing care hospitals, long term care homes and nursing agencies be urged to provide a comprehensive program to promote annual influenza immunization of health care workers (HCWs).
2. The Ontario Ministry of Health and Long-Term Care be requested to include annual institutional HCW influenza immunization rates as an indicator within the publicly reported Ontario Patient Safety Initiatives.
3. The Medical Officer of Health be requested to report annually on influenza immunization coverage rates among HCWs in Toronto healthcare facilities for the next three years.
4. The Ontario Minister of Health and Long-Term Care be urged to explore options to make annual influenza immunization mandatory for HCWs if coverage rates for healthcare institutions do not improve significantly over the next year.
5. This report be forwarded to the Chief Medical Officer of Health for Ontario, the CEOs of all Toronto acute care and complex continuing care hospitals, and long term care homes, the CEOs of all Toronto-area Local Health Integration Networks (LHINs) and Regional Infection Control Networks (RICNs), the General Manager of City of Toronto Long-Term Care Homes and Services, the Chief and General Manager of Toronto Emergency Medical Services (EMS), Toronto Practitioners of Infection Control (TPIC), the Ontario Agency for Health Protection and Promotion (OAHPP), all Ontario Boards of Health, the Association of Local Public Health Agencies (alPHa), and the Ontario Public Health Association (OPHA). |
Origin |
(October 6, 2009) Report from Medical Officer of Health |
Summary |
Influenza is an acute viral infection of the respiratory tract. Influenza can result in widespread illness, including outbreaks and pandemics, and it is associated with complications such as bacterial pneumonia and death. Annual immunization of persons at high risk, and of health care workers (HCWs) and others who are capable of transmitting influenza to those at high risk, is the most effective measure for reducing the impact of influenza. Annual influenza immunization of HCWs is recommended by the National Advisory Committee on Immunization (NACI) .
In order for immunization programs to be successful, high rates of coverage are required. However, influenza immunization coverage among HCWs in Toronto and Ontario remains low. During the 2008/2009 influenza season in Toronto, the median coverage rate for influenza immunization among HCWs working in institutional settings in Toronto was 42% for Acute Care Facilities, 55% for Complex Continuing Care hospitals, and 70% for Long Term Care Homes (Table 1). These rates are comparable to those reported for the previous two seasons (2006/2007 and 2007/2008) and with the exception of many LTCHs, lower than the annual influenza immunization coverage rate of 70% recommended by the Ontario Ministry of Health and Long Term Care (MOHLTC). Moreover, the median rates of immunization coverage among HCWs in Toronto institutions have been consistently lower than the provincial median rates over the last three years.
This report reviews the evidence supporting the public health importance of influenza immunization among HCWs, provides influenza immunization coverage rates for HCWs in Toronto hospitals (acute and complex continuing care) and long-term care homes (LTCHs), makes recommendations on how to improve the uptake of influenza immunization by HCWs, and provides an update on provincial recommendations for influenza immunization for the 2009/2010 influenza season. While this report focuses on the coverage rates, programs and surveillance activities for influenza immunization in Toronto healthcare institutions, the importance of influenza immunization applies to all HCWs, regardless of their place of employment. |
Background Information |
hl25.3 - Influenza Immunization Rates of Healthcare Workers in Toronto Healthcare Facilities - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24123.pdf) |
Communications |
(October 19, 2009) Letter from Aliss Terpstra (HL.New.hl25.3.1) |
HL25.4 | Information |
Received |
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Ward: All |
Ministry of Health Promotion Funding Reduction to Smoke-Free Ontario Enforcement |
Committee Decision |
The Board of Health received, for information, the report (September 29, 2009) from the Medical Officer of Health. |
Origin |
(September 29, 2009) Report from Medical Officer of Health |
Summary |
The purpose of this report is to further advise the Board of Health about Ministry of Health Promotion (MHP) funding reductions to the 100% funded Smoke-Free Ontario Act (SFOA) enforcement program.
As reported under item HL24.2 of the June 16 Board of Health meeting, MHP notified Toronto Public Health (TPH) of reductions to the Youth Action Alliance program, the High School Grants program and enforcement of the SFOA across Ontario. At the time of that report, MHP had not specified the amount of the reduction to the TPH enforcement program.
On August 25, 2009, MHP notified TPH that the enforcement funding allocation for the City of Toronto would be reduced by $99,561 based on the Ministry’s fiscal year (April 1, 2009 – March 31, 2010). This report will will outline the impact of this reduction on the TPH tobacco enforcement program. |
Background Information |
hl25.4 - Ministry of Health Promotion Funding Reduction to Smoke-Free Ontario Enforcement - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24020.pdf) |
HL25.5 | Information |
Received |
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Ward: All |
Ministry of Health and Long-Term Care Initial Report on Public Health |
Committee Decision |
The Board of Health received, for information, the report (October 1, 2009) from the Medical Officer of Health. |
Origin |
(October 1, 2009) Report from Medical Officer of Health |
Summary |
In August 2009, the Ministry of Health and Long-Term Care released its Initial Report on Public Health. The report provides a snapshot of the current state of public health in Ontario and examines public health as a system at both the provincial and local levels. Health unit profiles, indicators and case studies are included.
While the data presented in the report does not directly address the Ontario Public Health Standards (OPHS), it does provide an initial baseline to compare health units and signals the Ministry's move toward a performance management system for public health. |
Background Information |
hl25.5 - Ministry of Health and Long-Term Care Initial Report on Public Health - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24021.pdf) |
HL25.6 | Information |
Received |
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Ward: All |
Toronto Public Health Capital Budget Variance Report for the Six Months Ended June 30, 2009 |
Committee Decision |
The Board of Health received, for information, the report (September 25, 2009) from the Medical Officer of Health. |
Origin |
(September 25, 2009) Report from Medical Officer of Health |
Summary |
This report provides an update to the Board of Health on the Toronto Public Health (TPH) Capital Budget variance for the six-month period ended June 30, 2009 (Appendix 1).
Toronto Public Health spent $1.021 million or 18 percent of the 2009 approved cash flow of $5.670 million as of June 30, 2009.
The year-end capital expenditure is projected to be $3.800 million or 67 percent of the approved cash flow. |
Background Information |
hl25.6 - Toronto Public Health Capital Budget Variance Report for the Six Months Ended June 30, 2009 - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24023.pdf) hl25.6 - Appendix 1 - TPH 2009 Capital Budget Variance Report for the Six Months Ended June 30, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24024.pdf) |
HL25.7 | Information |
Received |
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Ward: All |
Toronto Public Health Operating Budget Variance Report for the Six Months ended June 30, 2009 |
Committee Decision |
The Board of Health received, for information, the report (September 25, 2009) from the Medical Officer of Health. |
Origin |
(September 25, 2009) Report from Medical Officer of Health |
Summary |
This report provides an update to the Board of Health on Toronto Public Health’s (TPH) Operating Budget Variance for the six months of operation ending on June 30, 2009 (see Attachment 1).
Toronto Public Health’s operating budget was under spent by $30.8 thousand net or 0.2 percent for the six-month period ending on June 30, 2009.
TPH gross expenditures were below budget by $3,669.0 thousand or 3.6 percent, attributable to the underspending of $9.4 thousand in Salaries and Benefits and $3,659.6 thousand in non-payroll. Revenue was underachieved by $3,638.2 thousand or 4.5 percent due to under-expenditures in provincial cost shared and fully funded programs, underachievement of Interdepartmental Revenue in the Ontario Works Dental program.
At year-end, TPH will be underspent due to savings from the labour disruption in the 2nd and 3rd quarter of 2009. This underspending will be partially offset by resumption of service costs. Currently, it is unknown how much will be spent on H1N1 outbreak response in the last two quarters of the year.
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Background Information |
hl25.7 - Toronto Public Health Operating Budget Variance Report for the Six Months ended June 30, 2009 - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24025.pdf) hl25.7 - Attachment 1 - TPH Operating Variance Submission for the Six Months ended June 30, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24026.pdf) |
HL25.8 | ACTION |
Adopted |
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Ward: All |
Budget Adjustment to the Toronto Public Health 2009 Approved Operating Budget and Confirmation of Authority to Sign Agreements |
Committee Decision |
The Board of Health recommended to the Budget Committee that:
1. City Council increase the Toronto Public Health 2009 Operating Budget for one-time funding of $500.2 thousand gross and $0.0 net, that is provided by the Ministry of Health and Long-Term Care to cover the cost of implementation of the PECS Solution used to manage electronic record keeping at the planned pH1N1 mass immunization clinics.
2. City Council confirm the authority of the Medical Officer of Health to execute the Protocol for Electronic Clinic System (PECS) License Agreement and the PECS Training and Service Agreement, between the Regional Municipality of Niagara and the City of Toronto, dated September 29, 2009. |
Origin |
(October 1, 2009) Report from Medical Officer of Health |
Summary |
The purpose of this report is to request a budget adjustment to Toronto Public Health’s (TPH) 2009 Operating Budget due to confirmation of 100 per cent funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC), for implementation of the Protocol for Electronic Clinic System (PECS), an integral part of which is the software solution known as Clinic Event Management System (CEMS). This system and software was developed by the Niagara Region Public Health Unit and is being recommended and funded for the use of Ontario Public Health Units by the Ontario Ministry of Health and Long-Term Care for the purpose of managing the electronic record keeping associated with the mass immunization clinics that are being planned as part of the pandemic H1N1 (pH1N1) response.
This report also seeks City Council’s confirmation of the Medical Officer of Health’s authority to enter into a licence agreement and an agreement for training and support with the Regional Municipality of Niagara for the purpose of implementing the PECS Solution to support electronic record keeping at the pH1N1 mass immunization clinics. |
Background Information |
hl25.8 - Budget Adjustment to the Toronto Public Health 2009 Approved Operating Budget and Confirmation of Authority to Sign Agreements - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24028.pdf) |
8a | Budget Adjustment to the Toronto Public Health 2009 Approved Operating Budget and Confirmation of Authority to Sign Agreements |
Origin |
(October 1, 2009) Letter from Board of Health Budget Sub-Committee |
Summary |
The Board of Health Budget Sub-Committee on October 1, 2009, considered a report (October 1, 2009) from the Medical Officer of Health, addressed to the Board of Health, entitled “Budget Adjustment to the Toronto Public Health 2009 Approved Operating Budget and Confirmation of Authority to Sign Agreements”. |
Background Information |
hl25.8a - Letter from the Board of Health Budget Subcommittee (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24008.pdf) |
HL25.9 | ACTION |
Adopted |
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Ward: All |
Toronto Public Health’s 2010 – 2019 Capital Budget and Plan Submission |
Committee Decision |
The Board of Health recommended to the Budget Committee that:
1. City Council approve a 2010 Capital Budget with a total project cost of $5.227 million and a 2010 cash flow of $0.843 million and future year commitments of $4.384 million as detailed in Appendix 3, “Toronto Public Health’s 2010 Capital Budget”. The 2010 Capital Budget Submission consists of the following:
a. new cash flow funding for:
i. two new sub-projects and five changes in scope sub-projects with a 2010 total project cost of $5.227 million that requires cash flow of $0.843 million in 2010, and future year commitments of $0.995 million in 2011, $1.508 million in 2012, and $1.881 million in 2013; and
ii. six previously approved sub-projects with a 2010 cash flow of $3.499 million and future year commitments of $2.858 million in 2010 and $1.892 million in 2012; and
b. 2009 approved cash flow for four previously approved sub-projects, with carry-forward funding from 2009 into 2010, totalling $1.870 million.
2. City Council approve a 2011-2014 Capital Plan of $4.919 million with future years estimates of $1.519 million in 2013; and $3.4 million in 2014 as outlined in Appendix 1 – Toronto Public Health 2010 Capital Budget and 2011-2019 Capital Plan.
3. The net operating impacts of $0.248 million for 2011, $0.149 million for 2012, $0.084 million for 2013, $0.018 million for 2014, and $0.007 million for 2015 emanating from the approval of the 2010 Capital Budget as detailed in Appendix 2, “Toronto Public Health 2010-2019 Operating Budget Impact of Capital” be considered within the future years’ Toronto Public Health Operating Budget submissions.
4. This report be considered by the Budget Committee during the 2010 budget process. |
Origin |
(September 29, 2009) Report from Medical Officer of Health |
Summary |
This report provides an overview of Toronto Public Health’s (TPH) 2010 Capital Budget, and 2011-2019 Capital Plan Submission for approval.
TPH is submitting a 2010 – 2019 Capital Budget and Plan request of $35.395 million, including a 2010 Capital Budget of $4.342 million and future year commitments of $ 9.134 million and a 2011 – 2019 Capital Plan of $21.919 million. The Debt Affordability Target provided by the City for TPH is $4.342 million in 2010, $3.853 million in 2011 and, $3.400 million in each year from 2012 to 2019 for a total of $35.395 million.
The 10-Year Capital Budget and Plan request will provide funding for thirteen Information and Technology (IT) projects that support improvement of service delivery with the development and enhancement of systems while complying with provincial mandatory reporting system requirements. The associated operating impact of these thirteen IT projects at the end of ten years is $2.485 million gross and $0.793 million net for ten new positions and ongoing costs for service and maintenance. |
Background Information |
hl25.9 - Toronto Public Health - 2010 - 2019 Capital Budget and Plan Submission - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24034.pdf) hl25.9 - Appendix 1 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24035.pdf) hl25.9 - Appendix 2 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24197.pdf) hl25.9 - Appendix 3 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24198.pdf) |
9a | Toronto Public Health’s 2010 - 2019 Capital Budget and Plan Submission |
Origin |
(October 1, 2009) Letter from Board of Health Budget Sub-Committee |
Summary |
The Board of Health Budget Sub-Committee on October 1, 2009, considered a report (September 29, 2009) from the Medical Officer of Health, addressed to the Board of Health, entitled “Toronto Public Health’s 2010 – 2019 Capital Budget and Plan Submission”. |
Background Information |
hl25.9a - Letter from the Board of Health Budget Sub-Committee (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24007.pdf) |
HL25.10 | ACTION |
Adopted |
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Ward: All |
Appointment of Associate Medical Officers of Health |
Confidential Attachment - Personal matters about an identifiable individual, including municipal or local board employees |
Committee Recommendations |
The Board of Health recommends that:
1. City Council appoint the physicians named in Confidential Attachment 1 as Associate Medical Officers of Health for the City of Toronto Health Unit.
2. City Council transmit Recommendation 1 to the provincial Minister of Health and Long-Term Care for approval of the appointments in this recommendation.
3. City Council repeal the by-laws appointing former Associate Medical Officers of Health outlined in Confidential Attachment 1.
4. City Council grant authority to introduce the necessary Bill in Council to appoint the physicians named in Confidential Attachment 1 as Associate Medical Officers of Health, subject to the approval of the provincial Minister of Health and Long- Term Care.
5. City Council grant authority to introduce the necessary Bill in Council to rescind the appointments of the Associate Medical Officers of Health named in Confidential Attachment 1. |
Origin |
(September 28, 2009) Report from Medical Officer of Health |
Summary |
This report recommends the appointment of two public health physicians as Associate Medical Officers of Health (AMOH) for the City of Toronto Health Unit and updates the status of AMOH appointment by-laws. |
Background Information |
hl25.10 - Appointment of Associate Medical Officers of Health - Staff Report (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24033.pdf) |
HL25.11 | ACTION |
Amended |
|
Ward: All |
Ontario Health Insurance Plan (OHIP) Coverage for New Immigrants with Tuberculosis |
Committee Decision |
The Board of Health requested the Chair of the Board of Health to send a letter to the Minister of Health and Long-Term Care urging that the three-month wait period for Ontario Health Insurance Plan (OHIP) coverage for new immigrants with Tuberculosis in Ontario be eliminated. |
Origin |
(September 17, 2009) Letter from Board of Health TB Sub-Committee |
Summary |
At the Board of Health TB Sub-Committee meeting on September 17, 2009, Dr. Elizabeth Rea, Associate Medical Officer of Health, TB Prevention and Control, addressed the Sub-committee regarding OHIP coverage for new immigrants with Tuberculosis and advised that Tuberculosis continues to be a serious public health concern in Toronto and increasingly throughout the GTA, related largely to immigration patterns, and filed a draft letter. |
Background Information |
hl25.11 - Letter from the Board of Health TB Sub-Committee (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-23869.pdf) |
HL25.12 | ACTION |
Amended |
|
Ward: All |
Future of the Board of Health TB Sub-Committee |
Committee Decision |
The Board of Health:
1. disbanded the TB Sub-Committee as a Sub-Committee of the Board of Health.
2. directed that the current members of the TB Sub-Committee continue to meet twice a year under the new name of the TB Coalition;
3. directed that one (1) member of the Board of Health be appointed to the TB Coalition;
4. appointed Fiona Nelson as the Board of Health representative to the TB Coalition. |
Origin |
(September 17, 2009) Letter from Board of Health TB Sub-Committee |
Summary |
The Board of Health TB Sub-Committee, on September 17, 2009, considered a verbal report from Marnie Kraguljac, Associate Director, TB Program, reviewing the accomplishments of the TB Program and the TB Sub-Committee to date, acknowledging the significant changes in the program for TB health and recommending that the Board of Health TB Sub-Committee discontinue its formal status as a Sub-Committee of the Board of Health. |
Background Information |
hl25.12 - Letter from the Board of Health TB Sub-Committee (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-23871.pdf) |
HL25.13 | Information |
Received |
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Ward: All |
North York Local Health Committee Minutes |
Committee Decision |
The Board of Health received, for information, the minutes of the North York Local Health Committee meetings held on April 21, 2009, May 13, 2009, and June 9, 2009. |
Summary |
• Minutes of the North York Local Health Committee meeting held on April 21, 2009.
• Minutes of the North York Local Health Committee meeting held on May 13, 2009.
• Minutes of the North York Local Health Committee meeting held on June 9, 2009. |
Background Information |
hl25.13 - North York Local Health Committee Minutes - April 21, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24131.pdf) hl25.13 - North York Local Health Committee Minutes - May 13, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24132.pdf) hl25.13 - North York Local Health Committee Minutes - June 9, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24133.pdf) |
HL25.14 | Information |
Received |
|
Ward: All |
Scarborough Local Health Committee Minutes |
Committee Decision |
The Board of Health received, for information, the minutes of the Scarborough Local Health Committee meetings held on May 11, 2009, and June 8, 2009. |
Summary |
• Minutes of the Scarborough Local Health Committee meeting held on May 11, 2009.
• Minutes of the Scarborough Local Health Committee meeting held on June 8, 2009. |
Background Information |
hl25.14 - Scarborough Local Health Committee Minutes - May 11, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24134.pdf) hl25.14 - Scarborough Local Health Committee Minutes - June 8, 2009 (http://www.toronto.ca/legdocs/mmis/2009/hl/bgrd/backgroundfile-24135.pdf) |
Meeting Sessions |
Session Date | Session Type | Start Time | End Time | Public or Closed Session |
2009-10-19 | Afternoon | 1:09 PM | 2:55 PM | Public |
Attendance | ||
Members were present for some or all of the time period indicated. |
Date and Time | Quorum | Members |
2009-10-19 1:09 PM - 2:55 PM (Public Session) |
Present |
Present: Chari, Cho, Davis, Filion (Chair), Fletcher, Lee, Nelson, O'Brien, Perks, Sterling Not Present: Bravo, Wong |