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Casino Calamity: One Gambling Guru Thinks The Province Is Going Too Far

By David South

Id Magazine (Canada), May 16-29, 1996

Will Ontario become saturated with gambling? It is a question being asked more and more as the provincial government moves to allow unprecedented choice for gamblers.

Bars and hotels will soon have video one-armed bandits (known as video lottery terminals and slammed by the Addiction Research Foundation as video crack) and permanent charity casinos will be set up throughout the province.

Finance minister Ernie Eves’ budget may have brought joy to the hearts of the province’s gambling fanatics, but whether this is sound economic policy is less certain. Eves hopes to reap $60 million this year from the VLTs, or fruit machines.

Speaking to id under anonymity due to the sensitivity of his work, a private gambling consultant to the provincial government says the extended gambling could monkey-wrench the government’s on-going plans to build casinos to attract American tourists.

He says, “There is a maximum to any market area, to the number of people who will come. In Ontario, the idea was to have monopoly markets to create jobs and revenue for government. Spreading casinos out on the border areas would maximize jobs. But the introduction of VLT machines and permanent charity casinos means there will be a narrowing of the market. As soon as you set up the VLTs, there will be a permanent impact.”

He believes littering the province with casinos – both large and small – and VLTs, will be the equivalent of pissing in the wind for the government, arguing tourists will only be attracted to Ontario casinos if they consist of only a few, flashy must-see attractions based on the Las Vegas model.

Tourist temptation

The focus on tourists is key. Research has shown that gambling aimed at residents living near casinos can actually harm other local businesses like restaurants and movie theatres, as people spend more of their entertainment budgets on gambling. Add to this equation the fact that most of the profits go out of the community to Queen’s Park, and a casino can hurt local economies.

Knowing this, the government has instead focused on attracting tourists. In the case of the Windsor casino, it has worked – 80 per cent of gamblers there come from the US. The economic equation is simple: every dollar sucked in by the casino is a net gain for Canada that doesn’t hurt any other Canadian businesses (as for Detroit, that is anther story).

If the government keeps on its current course, Ontario could have 10 working government-owned casinos in the near future. By year’s end, the Windsor casino will be joined by Niagara Falls and the Rama First Nations casino near Orillia.

According to Anne Rappe of the government-owned Ontario Casino Corporation public outrage could change plans. “The government has been clear in its commitment to letting voters voice their view on casinos for other sites.”

Just a fad

Governments, like people, follow fads. The trend towards harder forms of gambling, like casinos and VLTs, as opposed to softer gambling like lotteries, represents a desperate move by local governments to hang on to tax revenues.

Even more than flashy schemes to build theme parks, art galleries and museums, casinos are seen as a sure-fire way to revive ailing communities by attracting tourists. Throughout North America, consultants and casino companies are telling government to turn to gambling if they hope to boost public treasuries and generate jobs. The pitch in these hard economic times goes down a treat with governments beseiged by voters to, on the one hand, reduce debt and deficits, and on the other be seen to be creating economic opportunity in the age of downsizing.

Casinos also serve another purpose. While taxes seem punitive, making money off of gamblers appears on the surface to be a win-win situation. The government gets the money it wants,while gamblers get the adrenaline rush they crave, and maybe some cash. The whole arrangement seems to be victimless – if you want to gamble, you pay the price.

For their part, gambling advocates envision Ontario as a Mecca for American gamblers chasing our low dollar, low crime, no tax casinos. They say we can have it both ways: a safe, low-crime Ontario in which islands of gambling fever suck in much-needed American dollars to prop up the provincial government treasury.

Gambling has been legal in Canada since 1969 (though the oldest casino is the gold rush-era Diamond Gerties in Dawson City, Yukon), but it wasn’t until the New Democrat government of Bob Rae that the idea of government-run or sanctioned permanent casinos became an option in Ontario.

The gambling consultant says the appeal of casinos is that they offer a sure-fire anchor to a local economy. He criticizes other developments like theme parks for being “too risky.” To make the most money, he says, casinos should avoid any pretensions to be slick, high-society affairs and instead go after the folks with “the family restaurant-style dress code.”

While the casino in Windsor is a lucrative success for the government – taking in a “win” of $500 million – local businesses have yet to report any of that money coming their way. Gambling experts say that isn’t about to change. With $400 million going directly to the government, and the rest covering expenses and the management fee paid to an American consortium running the casino, there will be little left for anyone else.

The Windsor casino is also drawing criticism for being a social parasite on Detroit, which supplies 80 per cent of the casino users. The influx of $1 million into Windsor means between 2,000 and 3,000 jobs are lost in Detroit, according to gambling expert William Thompson of the University of Nevada. Because of this, it is believed Detroit will soon set up a casino if voters say so.

A 1993 Coopers and Lybrand study commissioned by the government estimated Windsor’s win would be reduced by 60 per cent if Detroit were to open a casino.

That same study strangely found comfort in its findings that the average “pathological gambler” is male, under 30, non-Caucasian, unmarried and without a high school diploma.

It then goes on to say, “The typical US casino gaming patron earns thirty per cent more than the average of the US population, is between the ages of 40-64, is college educated and lives in a household of two or more members.” Just the kind of market that sends corporations into ecstasy.

Quebec example

The Quebec experience offers some valuable lessons for Ontario. Quebec’s three casinos were also looking to be a success until recently. The Quebec government and gambling advocates maintained the casinos (located in Montreal, Pointe-au-Pic and Ottawa’s sin-bin, Hull) were squeaky clean. Just like in Ontario, they remarked upon the impressive revenues – $1 million a day – and the huge influx of tourists. But closer scrutiny reveals the three casinos have not come without a cost.

Both Montreal and Pointe-au-Pic casinos have been criticized for preying on poor locals who spend the pittance out of their entertainment budgets on gambling. The casinos have also been involved in high-profile drug busts, money laundering scams and even murders committed by gambling addicts trying to extort money from relatives. At the Montreal casino, enterprising youth gangs targeted winners as they left the casino when it closed at three am. The robberies worked like this: A confidant would spot winners in the casino and then use a cellphone to tell accomplices waiting outside to mug the unsuspecting “lucky” ones still intoxicated by their good fortune.

All the rosy projections about casinos reviving the Ontario economy are based on several key assumptions: Americans will be the main users of the casinos, casinos in Ontario will not compete with each other or other sectors of the economy (restaurants, movie theatres, etc.), the social costs will be low and crime will not increase significantly, and most importantly, American casinos won’t lure away gamblers.

As for the gambling consultant, he doesn’t think the casinos slated to open later this year in Niagara Falls will drag the city down any farther. “Niagara Falls isn’t the nicest place now. The casino will finally give an economic reason to upgrade these places (hotels, motels and restaurants).”

And while the Niagara Falls casino will most certainly be popular, it will not be able to operate free of competition for long. Across the Rainbow Bridge at Niagara Falls, New York, preparations are being made to open a casino by 1997.

Windsor will also face competition from the American side. Voters in the state of Michigan will be asked to vote on whether to allow casinos at the next state elections. Several groups, including a local Indian band, have been pushing for a casino to be located in downtown Detroit. Canadian casinos must also compete with river boats from Illinois and Indiana.

The government has reached a watershed in its gambling policy, leaving it with few choices. It can either allow unfettered growth in casinos as more and more communities scramble to find any means necessary to generate jobs and tax revenues, or it can recognize there is a limit to gambling as a solution to economic woes.

As the source says, “The government is in a quandry: they like the revenue but hate the way it is raised.”

Id Magazine was published in the mid to late 1990s in Canada.
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Psychiatric Care Lacking For Institutionalised Seniors

Don Weitz wears a T-shirt bluntly saying, “Fry rice – not brains.”

By David South

Today’s Seniors (Canada), November 1992

Seniors who live in nursing homes and homes for the aged are receiving an inadequate amount of psychiatric care, according to a study conducted by Toronto’s Baycrest Centre for Geriatric Care. 

Dr. David Conn, director of psychiatry at Baycrest and an author of the report, says action must be taken to remedy this situation, since at least 80 per cent of elderly long-term care residents suffer from some form of mental disorder. 

The issue of psychiatric care for seniors is complex. There are many, often strongly-held, opinions about the nature of this care and what measures will genuinely improve the mental well-being of seniors in institutions. 

According to The Senior Citizens’ Consumer Alliance for Long-Care Reform, Ontario has the highest rate of institutionalisation of seniors in the world, with 7.5 per cent of seniors over the age of 65 and 15 per cent over 75 in institutions. The Alliance demanded in its reforms in Ontario that seniors’ mental health problems be taken more seriously and be included in any assessment for care. 

Baycrest’s report surveyed 1,148 medical directors and nursing directors in over 500 nursing homes and homes for the aged across Ontario. The 601 who responded reported that 37 per cent of their residents received no psychiatric care, while only 12 per cent received more than five hours per month. The most common psychiatric problems under treatment were depression, agitation, wandering and physical aggression. 

“Recognition of significant mental disorders in nursing homes is a recent phenomenon because geriatric psychiatry is a relatively new field,” says Dr. Conn. “The usual approach has been to reach for the prescription pad. We know now that antidepressants have been underused and tranquillizers overused.

“To deliver effective psychiatric care requires more than just psychiatrists – teams of psychiatric nurses can also be involved. Hopefully the staff of these institutions will become better educated as a result of this report.”

Dr. Kenneth Shulman, head of psychiatry at the Sunnybrook Health Sciences Centre, feels the worst neglect occurs in private rest homes. 

“There is general lack of accountability when it comes to geriatric psychiatric services.” Schulman advocates a coordinated, comprehensive regional network of services. 

Dr. Conn is sensitive to reports of sexual, physical and mental abuse of residents in some institutions. He says staff as well as residents of institutions can benefit from psychiatric consultations. “If more psychiatric consultants were available, the staff could also receive help in working out their problems,” he says. “Unfortunately the fee-for-service system doesn’t include paying for visiting staff.

“Being in an institution is not easy for anyone. It often means being apart from family, living with strangers, loss of freedom and having to live by the institution’s timetable.”

One of the most controversial of psychiatric treatments is electroconvulsive therapy (ECT). ECT involves placing electrodes on the sedated patient’s head and passing 100 to 175 volts of electricity into one of the lobes of the brain to induce grand mal seizure and coma. 

Opponents of ECT say the procedure can cause memory loss and confusion, and in some cases proves fatal. A 1985 Ontario government task force report recommended against using ECT in certain cases: “For patients whose work requires a clear and precise memory, ECT is probably contraindicated.”

But many other sources say that while ECT has been abused in the past and, like many other medical procedures, may not be a pretty sight, it is sometimes effective in combating depression. 

Dr. Conn confirms that the controversial procedure is still being used on seniors. “ECT is used on very depressed people,” he says. “It is a hospital-based service. The patient is admitted to a psychiatric unit of the hospital. We do it at Baycrest. It is only a last resort and has often been life-saving.”

Don Weitz, a senior citizen and spokesperson for Resistance Against Psychiatry, doesn’t mince words about what he says is the adverse effects of electroshock therapy and psychiatric practice in general. He wears a T-shirt bluntly saying, “Fry rice – not brains.”

“We have known about the adverse effects of shock for years,” says Weitz. “Research from the ‘40s and ‘50s was very clear that there was brain damage.

“What doctors mean by improvement is in fact post-injury euphoria – the brain will overcompensate with giddiness, and this only lasts for two to four weeks. Doctors seldom test people for more than two or three months afterwards.”

“What we know for sure is that within the institutions, they would rather give drugs or shock than talk to seniors. I think this should be called elder abuse – what else could it be? Is it such a mystery why people are depressed in institutions where they are abused? Psychiatrists have a vested interest in billing OHIP for pushing the button.”

But Dr. Shulman disagrees with blaming the atmosphere of institutions. “It is simplistic to think that the environment is responsible for aggressiveness or other problems,” he says. “These people are cognitively impaired – it could be medication-related or something else. These are complicated issues.”

For any nursing home workers who want further advice about psychiatry, Baycrest has produced a “Jargon-free” guide called Practical Psychiatry in the Nursing Home. 

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Specialists Want Cancer Treatments Universally Available

By David South

Today’s Seniors (Canada), December 1993

A newly-formed group representing cancer doctors says it is fed up with the inhumane and bureaucratic approach to cancer care in Ontario. 

Dr. Shailendra Verma of Access to Equal Cancer Care in Ontario (AECCO) says he’s had enough. 

“My group has served the government notice that we’re fighting on our patients’ behalf,” says Verma, who faces gut-wrenching quandaries every day in his growing Ottawa practice. “In a public health system, I’m damned if I’m going to be divided into giving one set of patients a Cadillac treatment and the other Hyundai-type treatment; I don’t think that’s why we have a public health system.”

Verma says cutbacks to health care funding have meant that doctors must leap increasingly high hurdles to get the drugs their patients need. 

In jeopardy

While chemotherapy drugs administered in hospitals are still free, he says the important drugs necessary for patient comfort and treatment effectiveness are in jeopardy. 

These drugs were once free under the Ontario Drug Benefit Plan (ODBP), but now their status is tenuous. One drug, GCSF – which is crucial in helping patients between treatments of chemotherapy – is now listed under Section 8 of the ODBP and requires doctors to plead with the government each time for coverage. Often the bureaucracy moves so slowly that the course of chemotherapy is seriously disrupted, Verma says. 

“As an oncologist I’m particularly interested in ensuring everyone has access to all treatment. I think we are at a very sensitive crossroads. Over the last three or four decades we’ve developed certain treatments for diseases that more often kill than cure. And now we are at a point where we’ve got new treatments that can make the older treatments more effective. Or we’ve got brand new treatments that we are hoping to apply, and the one thing that is holding us back is cost.”

Cost

“The decisions are not based on science, they’re based on cost. It would not be an issue if treatments cost a penny a shot.”

Verma says colleagues can’t introduce some new drugs because the costs would be too high to offer it to everyone. So no one gets it.

“We have patients who walk in and say they would like to pay for it,” continues Verma. “Ethically, as a physician do you allow a patient to pay for it while sitting next to a similar patient who can’t afford it?”

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Seniors Falling Through The Health Care Cost Cracks

By David South

Today’s Seniors (Canada), December 1993

When Orangeville senior Donald Potter was told he was too old to receive a bone marrow transplant, he paid $150,000 to get one in the United States. 

His case, recently made public by provincial Conservative leader Mike Harris, has raised the disturbing issue of health care rationing for seniors. 

Potter, who has Hodgkin’s lymphoma, says he was told the cut-off age is 55; since he was 64 at the time he needed a transplant, he was told last February it was too risky to obtain the procedure. Faced with a few months to live, he went to Rochester, New York, where bone marrow transplants were done on patients into their late 70s. 

Money

Potter believes the real issue is money. The government doesn’t have enough, so he couldn’t get the treatment that could save his life. 

Cost-cutting resulting from the provincial government’s social contract and expenditure control plans has left physicians with the quandary of serving more people with less money. This dilemma has led them to prioritize who gets services, though physicians maintain such decisions are based on many factors other than age, including lifestyle, prognosis and effectiveness of the therapy. 

Transplants

Bone marrow transplants are a particularly emotional issue for Premier Bob Rae, who in early October was driven to tears handling questions regarding rationing of this service. His brother died of lymphatic cancer in 1989 after a failed bone marrow transplant for which Premier Rae was the donor. 

“I can’t knock the system that hard, I just don’t feel the government spends the money properly,” says a calm and unresentful Potter.

Many seniors are frightened when they hear the government needs to make cuts, fearing they could be the first to go when it comes to allocating rationed services. 

“From the perspective of seniors it is a very scary time right now,” says David Kelly of Toronto’s Senior Link, a community social service agency. “Everything is being questioned, all our social services. Instead of looking at how to solve the problems, we’re just going to cut out things, and that’s going to be our solution. It doesn’t necessarily work.”

The issue of rationing services based on age is a dicey one. Ministry of Health spokesperson Layne Verbeek says the schedule of benefits makes no mention of age; and he’s right, because that would be unconstitutional. But when a doctor is presented with a fixed budget and a bulging sack of patients, the physician on the hospital ward has to decide who gets treated and with what. How a physician does this is theoretically based on a combination of factors, but doctors also have prejudices and misconceptions. 

Rationing

Many argue such queuing is a dangerous departure from the belief that the sick deserve to be treated. 

“Part of the problem is that few would admit to rationing on the basis of age alone,” says bioethicist Eric Meslin of Toronto’s Sunnybrook Health Science Centre. “Most clinicians I’ve spoken with and worked with recognize that age alone is not a relevant criterion. But most clinicians would agree age does play a role in thinking about limiting care.”

Meslin admits the idea of denying health services based upon age alone has been making the rounds among health care professionals. 

Ethics

“There has been a debate in the last seven years in North America over whether age-based rationing is ethically acceptable,” says Meslin. “There is of course a spectrum of views, including the very extreme that says after a certain number of years you have obtained your benefit from society and you should step aside and allow others to make use of those resources.”

Meslin doesn’t feel good about going through any kind of health care rationing without a public debate over society’s values and what to expect from the health care system. 

And he is adamant that anybody who focuses solely on attacking the high costs of high-tech medicine and an aging population is making a value judgement about how society should spend its money, not stating a fact.

“A clinician who chooses to discriminate based on age alone is not only unethical, but unconstitutional. Having said that, no clinician worth their salt would be telling the truth if they did not consider who the patient was in the fullest sense of the term, including their age. However, not giving treatment because they are 80 is a numbers game; there isn’t good enough data to support it.” 

Meslin suggests a public debate on rationing services needs to take place. 

Needs

“We need to ask the elderly population what they want. It may be that they don’t want the kind of things the researchers and clinicians believe they want.”

Kelly at Senior Link believes cuts to free drugs are already one example of rationing. 

“There are a lot of ways we can go about changing our social services without cutting income support or access to medication. The same goes for what procedures will be performed,” says Kelly. 

Potter’s case graphically shows the human cost of the heavy hand of bureaucrats in a public system trying to save money. But the high cost of U.S. health care also leaves a bad taste in Potter’s mouth. 

“In the States, the cost is horrendous. At least we have that protection. But I happen to be one of the unfortunate ones that fell into the wrong slot. And there’s a lot of people like me.”