Dear Colleagues,

Of late, there has been an incredible amount of misinformation coming from the Registered Nurses Association of Ontario (RNAO) and other organizations with regard to our international activities at University Health Network so we feel compelled to set the record straight.

Our international work is based on three important principles. The first is that no Ontario patient be displaced by care given to an international patient. The second is that no money given to us by the Ministry of Health and Long Term Care is spent to care for international patients. And, the third is that money earned from this work is used to decrease wait times for Ontario patients. These principles have been articulated by the Provincial Government on a number of occasions, including by Minister Hoskins. We think these principles are appropriate and we are working with them.

UHN's Board of Trustees, as the volunteers responsible for these principles and their application, receives a report on a quarterly basis about our international activities, the revenues that come to UHN and how these revenues are spent to benefit Ontario patients. In the current fiscal year – from January to June – a total of 75 patients from 23 countries received care at UHN with our Libyan program accounting for 33 patients of the 75 patient total. UHN sees over a million patient visits in any calendar year and revenues for all elements of the international activities amount to about $30 million with the vast majority coming from consulting services outside Canada.

The RNAO, and other organizations, should not be talking about our international activities in a way that intentionally misleads people, while ignoring the very real  benefits to the health system in Ontario and the patients in our hospitals.

As an example, the Princess Margaret Cancer Centre which provides care to Ontario patients has a consulting contract to work with the Kuwait Cancer Control Centre (KCCC). In order to do this work in Kuwait, we committed to taking the occasional Kuwaiti patient needing a procedure that is so specialized that it cannot be done in Kuwait. The care of these patients is funded by the Kuwait Ministry of Health. This is not 'medical tourism' and to suggest that it is, is grossly unfair. It is specialized work that has always been available to international patients at a variety of hospitals in Canada providing that the governments sending these patients pay for the care. We have extraordinary health care in this country and we should be proud of being able to offer care to people in extreme distress, if we are paid for the work and it benefits our system.

Recently an offer of assistance to children injured in the conflict in Gaza seemed to find favour with a variety of organizations. There didn't appear to be a secure source of funding for this work and we simply don't understand why that is acceptable, while providing care to Libyans injured in the Libyan conflict is unacceptable, even though the monies received from Libya are paying for additional care for Ontarians. The Canadian government and a group of Canadian-Libyan physicians have supported this effort in a variety of ways. The money for this care was deposited in Canada and we have opened beds to provide this care and additional Operating Room (OR) capacity. These beds and OR time are occupied by Ontarians about 85% of the time – which is additional care for Ontarians. If this program ends, these beds will close which means our waiting list will lengthen.

The RNAO and other organizations seem to ignore the fact that hospitals and a host of other health care organizations in Ontario could create additional capacity if they had additional operating funds. We would welcome additional operating dollars in the health care system but we are also aware that funds are going to be very tight in the next few years. We've done a great deal at UHN to make ourselves lean and efficient – but the demand is rising and efficiencies will only take us so far. Without additional operating dollars in the system – and they don't necessarily have to be in hospitals – we are going to be struggling with wait lists for some time.

As most people understand, every hospital in the Province of Ontario has to balance its budget. We have seen several years of no increase to our budgets, with very little in the way of additional funds expected in the foreseeable future.  Our costs rise each year and we are being expected to manage increases is salaries, increases in drug costs, and increased utility bills while maintaining or increasing the care we provide. This additional revenue from international activities helps UHN deliver more care for the people of this Province. We are clear in our responsibilities and in our commitment to the health care system. If the RNAO and others succeed in stampeding people with their rhetoric, we will lose approximately $30 million in revenues that help us maintain our levels of care.​

We do not believe that this is a reasonable outcome because the loss of revenue would inevitably lead to longer wait lists, lost jobs, a decrease in our ability to fund innovation and a loss of opportunity for our staff to expand their capabilities.


Charlie Chan               Marnie Escaf               Nizar Mahomed          Joy Richards​

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