August 13, 1998
To:Emergency and Protective Services Committee
From:Acting General Manager, Toronto Ambulance
Subject:Additional Provincial Downloading Costs for Toronto Ambulance
Purpose:
To advise Toronto Council of additional budget pressures that the Province is imposing on
Toronto Ambulance as a result of decisions it has made respecting the withdrawal of
funding for previously funded equipment, and the requirement that Toronto Ambulance alter
the type of certain supplies it uses.
Funding Sources, Financial Implications and Impact Statement:
The financial impact of the Ministry of Health mandated changes is estimated at this point to
be in the range of $190,000 to $290,000, as a minimum. This is a cost that the Department
had not budgeted for in its 1998 operating budget submission, and represents an amount it
would wish to pursue as part of its 1999 operating budget request. It must be noted that it is
also a cost that the Department has had no control over.
Recommendations:
"It is recommended that:
(1)this report be received for information only at this time; and
(2)once Toronto Ambulance has reported back with a more precise estimate of the costs
related to these additional downloading pressures, Toronto Council, as part of the 1999
Operating Budget process, give due consideration to a request by Toronto Ambulance for
an increase in its 1999 operating budget equal to the amount of the final estimate."
Council Reference/Background/History:
Toronto Ambulance submitted a previous report (Clause 8 of Report No. 3 of the
Emergency and Protective Services Committee) which described in general terms the
impacts of the provincial downloading of ambulance services to municipalities, and
specifically to the City of Toronto. The report was adopted by Council at its meeting of
April 16, 1998.
In addition to the broader costs of downloaded ambulance service, Toronto Ambulance was
placed in a position of having to request an increase of $2.5 million in its 1998 operating
budget, in order to compensate for the elimination of vehicles and equipment which had
been supplied at no cost by the Ministry of Health for the previous seven years.
Comments and/or Discussion and/or Justification:
The additional downloading pressures facing Toronto Ambulance come from the following
two areas:
Advanced Life Support Care Drugs:
The Ministry of Health, through the Toronto Base Hospital (Sunnybrook Health Science
Centre), has previously supplied Toronto Ambulance with a number of its controlled drugs.
As a direct result of downloading, and of reevaluation of the funding of Base Hospitals
brought about by changes to the Ambulance Act, the Ministry is no longer prepared to offer
these items. As a consequence, Toronto Ambulance will have to make up the difference in
their funding.
The Department is in the process of acquiring an exact costing of the value of the drugs
from the Base Hospital. Our preliminary estimate puts the amount in the range of
$130,000.00.
Latex Products:
Currently, Toronto Ambulance spends approximately $40,000 per year on disposable
gloves. The Ministry has directed that all gloves used by ambulance services anywhere in
the Province must be made of non-latex synthetic material. The Department presently offers
both latex and vinyl (non-latex) gloves to its staff, however, the Ministry has now indicated
that in the near future vinyl gloves will also no longer be acceptable.
The Department has pursued a conversion from latex to non-latex, non-vinyl gloves. The
cost of this change is substantial, and will depend on the quality of the glove chosen, and
whether the glove meets the relevant Canadian General Standards Board (CGSB) standard
or equivalent (a market standard for examination gloves). It is calculated that the annual cost
of these gloves will be anywhere from $100,000 to $200,000.
In addition, there are suggestions there will be further directions from the Ministry that all
products used on ambulances must be entirely latex free. In order to comply with the
anticipated change in requirements, Toronto Ambulance has requested that all of its
suppliers of medical equipment and materials advise us if their products contain latex in any
part. To this point, no replies have been received and, therefore, the cost differential of
converting all latex containing products to non-latex has not yet been determined. However,
the costs will be in excess of those outlined above.
Prior to provincial downloading of ambulance services, the increased costs of any Ministry
directed changes to equipment specifications or supplies would have been borne by the
Ministry. Currently, though, it is expected that individual ambulance operators will have
now have to absorb the costs..
Summary Projected Cost Increases:
Based on the best available information today, the overall cost of the downloaded items is as
follows:
Drugs:$130,000
Gloves (additional costs):$60,000 - $160,000
Other latex materials:Unknown
Total:$190,000 - $290,000
Conclusions:
The total potential cost increases related to the Ministry directed changes will range from
$160,000 to $190,000, though the cost may be much higher depending on whether we will
also be required to convert to use of all non-latex products. Again, these are costs
completely beyond the control of Toronto Ambulance, and which cannot be easily absorbed
in our present operating budget. Therefore, Toronto Ambulance is requesting consideration
for a possible increase to its 1999 operating budget.
Once we receive more definitive information about the totality of the changes required, and
of the specific costs involved, we will report back again to Council, or through the 1999
Operating Budget process, as appropriate.
Contact Name:
Ron Kelusky
Phone:397-9240
Fax:392-2115
Ron KeluskyBarry Gutteridge
Acting General ManagerCommissioner
Toronto AmbulanceWorks and Emergency Services
